months, but upon publication of the first report of the results
accomplished it was decided to keep the school open a longer period. The
desire to open other schools of similar type spread rapidly throughout
Germany, as well as the rest of Europe and other parts of the world.
Probably the best argument for maintaining such schools was not only the
physical benefit derived, but the actual advance made by the children in
their studies, although they spent less than half as much time on school
work as did their companions in the regular schools, not only fully
maintaining their standing, but ever surpassing their companions in the
regular classes. Through results obtained from this first experiment in
Charlottenburg came the resolve on the part of school authorities of other
cities to inaugurate Open Air Schools in their respective localities, and
in less than three years the movement had spread to England, where, in
1907, London opened her first school, modeled after that of
Charlottenburg.
The same remarkable results obtained during the first season here, as in
the three years previously reported from Charlottenburg, awakened such
popular enthusiasm that towns and cities in different parts of England
began to plan for similar schools in the communities most needing them.
Meanwhile, the movement spread to the United States. In 1908, one year
after England had established her first Open Air School, this country
opened its first Open Air School in Providence, Rhode Island. Although
Providence has the distinction of priority in this matter, the school
inaugurated by Providence was not, strictly speaking, the first Open Air
School established on American territory, as a school of this type was
opened in 1904 in San Juan, Porto Rico, by L. P. Ayres, now Associate
Director of the Department of Hygiene of the Russell Sage Foundation, at
that time Superintendent of Schools for Porto Rico. The San Juan school
was an experiment. It was built to accommodate 100 children. It was simple
in its arrangements; it had a floor and roof but no sides. Venetian blinds
were provided to keep out rain and the too direct sunlight. The school was
designed for children of no particular class, but was established in the
endeavor to demonstrate that the regime which has proven beneficial for
weak and ailing children will also benefit those that are strong and
seemingly healthy. The results demonstrated fully the correctness of this
idea. The children greatly preferred the outdoor classes, and even the
teachers were most anxious to be assigned to outdoor work. Since then at
least one more school of similar type has been opened in Porto Rico.
Before showing what the United States has done in this very important
movement, it might be interesting to learn how Germany and England have
further developed their program, as the work done in these countries,
particularly in Germany, served as the basis of the Open Air School
movement in this country in the initial stages of its development.
For the past fifteen years Germany has carried on medical inspection of
schools in a very thorough and efficient manner. This has drawn special
attention to backward children. These children are treated there in
special classes and sometimes in special schools. The quantity of
instruction given them is reduced and every endeavor is made to increase
its effectiveness. The classes are taught by capable teachers and the
children have the benefit of suitable dietary, bathing and other hygienic
provisions.
In Charlottenburg, in 1904, there were a large number of backward children
who were about to be removed from the ordinary elementary schools to
special classes. When examined, it was found that many of them were in a
debilitated condition owing to anaemia, or various other ailments in an
incipient stage. This circumstance afforded an ideal opportunity for the
co-operation of the teacher and the school physician in devising and
operating, for such children, an Open Air School. The general school
regime was modified to meet the educational and physical needs of these
children, the treatment consisting, as above stated, of abundance of fresh
air, pleasant and hygienic surroundings, careful supervision, wholesome
food and judicious exercise. The ordinary school work was modified to meet
the individual condition of children; the hours of teaching were cut in
two and the classes so reduced that no teacher had more than twenty-five
pupils under her care. The site chosen for the first school in
Charlottenburg was a large pine forest on the outskirts of the town. The
sum of $8,000 was granted by the municipality for carrying out the plan,
and inexpensive but suitable wooden buildings were erected. At first
ninety-five children were admitted to the school, but later the number was
increased to 120, and still later to 250. These children were mainly
anaemic or suffering from slight pulmonary, heart or scrofulous
conditions. Those suffering from acute or communicable diseases were
rigidly excluded. Of the five buildings erected, three were plain sheds
about 81 feet long and 18 feet wide, one of them being completely open on
the south side and closed on the other sides, of sufficient size to
shelter during rainy weather about 200 children. The other two sheds
contained five classrooms and a teachers' room. These were closed in on
all sides, provided with heating arrangements, and used for classrooms
during very cold or unpleasant weather, only one of the buildings was
fitted with tables and benches intended for meals, or for work in
inclement weather. This building was open on all sides. All over the
school grounds, which were fenced in, there were small sheds open on all
sides, fitted with tables and benches to accommodate from four to six
children. These served as shelters. There were small buildings for shower
baths, kitchen and a separate shed where the wraps of the boys and girls
were kept. In these were individual lockers which contained numbered
blankets for protection against cold, and waterproofs against rain.
The children in this school report at a little before 8 a. m. and leave at
a quarter of 7 p. m. For breakfast they are given a bowl of soup and a
slice of bread and butter. Classes commence at 8 o'clock and continue with
an interval of five-minutes' rest after each half hour. At 10 a. m. the
children receive one or two glasses of milk and a slice of bread and
butter. After this they play, perform gymnastic exercises, do manual work
or read. Dinner is served at 12:30 p. m. and consists of about three
ounces of meat, with vegetables and soup. After dinner the children rest
or sleep for two hours on folding chairs. At 3 p. m. comes more class work
and at 4 p. m. milk, rye bread and jam is given. The rest of the afternoon
is given over to informal instruction and play. The last meal consists of
soup, bread and butter, after which the children are dismissed. Some walk
home; some use street cars. In case of the very poor children the city
pays the fare, while the transportation is furnished for others through
the generosity of the street car company. The expense of the feeding is
borne by the municipality, in the case of those who can not pay, and, for
the others, is defrayed in part or whole by the parents.
The work of the school physician consists of careful examination,
treatment and supervision of these children. Attention is principally
directed to heart, lungs and general condition with respect to color,
muscular and flesh development. Weight and measurements are taken every
two weeks, and at the end of the school period the children are very
carefully examined and condition compared with that noted upon their
admission.
The regime covers such important phases of hygiene as suitable clothing,
attention to daily habits, bathing, giving of warm baths for those who are
anaemic and nervous, and of mineral baths for those who are scrofulous.
Bathing plays a very important part. All of the children receive two or
three warm shower baths a week. A trained nurse is in attendance.
The educational, physical and moral results obtained are remarkable. There
is a great improvement in their behavior, especially with regard to order,
cleanliness, self-help, punctuality and good temper. This is undoubtedly
due to their removal, during practically all of their waking hours, from
the influences of the street life to the more wholesome influences of the
school. The children are taught to regard themselves as members of a large
family, are trained to assist in the daily work and are taught to be
helpful and considerate of each other.
This, in detail, is the regime of the first Open Air School conducted in
Germany.
The number of Open Air Schools at present in Germany is at least ten, with
an attendance of approximately 1,500.
* * * * *
In England the Open Air Schools were made possible through the work of the
local educational authorities and co-operation of dispensaries for
treatment and care of tuberculous children.
As in other countries, general legislation for the control of tuberculosis
has had considerable bearing on the Open Air School situation in England.
Among the legislative acts should be mentioned:
(a) The Act of 1911 providing building grants for the
establishment of sanatoria, dispensaries and other auxiliary
institutions.
(b) Compulsory notification of tuberculosis, etc.
Notification of tuberculosis, for instance, besides bringing to notice of
the school medical officer cases of tuberculosis which might otherwise not
come before him until a late period, serves in many cases to keep him
informed as to "contact cases"--cases of children in contact with
communicable tuberculosis.
At Burton-on-Trent a system was instituted for periodical examination of
school children who are either members of a family in which there is or
has been a case of pulmonary tuberculosis, or who are attending school
while residing in houses in which there is an existing case of this
disease. All notified cases of tuberculosis are visited by the Assistant
Medical Officer of Health, who is also Assistant School Medical Officer,
and the names of any children living in the house, or related to the
case, are ascertained, together with the school they are attending. These
names are entered in a special register and when the pupils of a school,
at which any of these children are attending, are examined, a special
examination is made of the latter. This examination is repeated two or
three times a year.
In another part of England a special letter is sent to the occupants of
all houses from which the disease has been notified, calling attention to
the special importance of early detection of tuberculosis in children, and
asking that the children should be brought to the school clinic for
examination.
In Lancashire the Medical Inspector calls on the Medical Officer of Health
and obtains a list of names of persons suffering from tuberculosis, so
that the children, if of school age, may be examined.
At Newcastle-on-Tyne all children exposed at any time to infection are
kept under observation and re-examined. The re-examination continues even
after fatal termination of the tuberculosis case with which the child was
in contact.
Under the Finance Act of 1911 a sum of about $500,000 was especially
appropriated for providing what are known as "Sanatorium Schools" for
children suffering from pulmonary or surgical tuberculosis. These schools
are known as the Residential Open Air Schools of Recovery, and the need of
such schools for children requiring more continuous care than is provided
at a day Open Air School is becoming widely recognized. Many children of
the type already mentioned can not be satisfactorily treated unless they
can be taken completely away, for a time, from their home environment.
Such treatment as is needed for many of these children is not and can not
be offered in the ordinary hospital and certainly not at their homes.
The designs and arrangements of the Residential Open Air School of
Recovery are very attractive. They are well equipped to fulfill their
function. The children, received between the ages of seven and twelve
years, are those suffering from anaemia, debility, or slight heart
lesions. Cases of active tuberculosis are barred. No child is received for
a shorter period than three months, and this period may be prolonged on
the recommendation of the Medical Officer.
The children rise at 7 a. m. and retire at 6:30 p. m. Those who are able,
make their own beds and do some of the domestic work. The diet is liberal,
with abundance of milk and eggs. Careful attention is given to inculcating
habits of personal and general hygiene. All children receive a daily bath.
Careful attention is paid to the teeth, tonsils and adenoids. All these
conditions must be attended to before admission. Beyond this, very little
treatment is given. Children are weighed once in two weeks. Instruction is
chiefly practical. Instruction in gardening is given twice a week and
other occupations taught are raffia work, plasticine modeling, cardboard
modeling, brush work and needle work.
The number of Open Air Schools at present in England is at least
thirty-five, with an attendance of at least 2,500. Forty-two other cities
are listed as carrying on some form of open air education.
* * * * *
In the United States the Open Air School movement, from its inception, has
been closely connected with the general anti-tuberculosis movement.
The credit of establishing the first Open Air School in America belongs,
as previously stated, to Providence, Rhode Island, where the work was
begun in January, 1908. The school was opened in a brick school house in
the center of the city. A room on the second floor was chosen and
remodeled by removing part of the south wall. For the wall thus removed
windows were substituted. These extended from near the floor to the
ceiling, with hinges at the top and with pulleys so arranged that the
lower ends could be raised to the ceiling. The desks were placed in front
of the open windows in such a manner that the children received the fresh
air at their backs and the light over their shoulders. Suitable clothing
was provided for cold weather and, in case of necessity, soapstone foot
warmers were used.
The school was started as an ungraded school and ten pupils were enrolled
at the time of its opening, the number later increasing to twenty-five.
Practically all children were selected by the visiting nurse of the local
League for the Suppression of Tuberculosis from infected homes under her
supervision. In a few instances children with moderately advanced lesions
were admitted.
The children reported at 9 a. m. and a recess was given at 10:30, when
they were served soup. At noon they had a light lunch of pudding served
with cream, hot chocolate or cocoa made entirely with milk. Some of the
children brought additional food from home. All of the cooking was done by
the teacher. Careful attention to general cleanliness and hygiene of the
teeth was insisted upon. Individual drinking cups and tooth brushes were
provided. The children took turns in washing dishes, setting the table and
helping to serve. Children were dismissed at 2:30 p. m. They were
provided with car tickets by the League for the Suppression of
Tuberculosis, some for traveling both ways, some for one way only,
depending upon the means of the family. During school session light
gymnastic exercises were given and proper methods of breathing taught. In
the spring they had a garden to work in.
The Providence school is at present a part of the general school system.
The school supplies and teacher's salary are furnished by the Board of
Education. Food and carfare are supplied by the League for the Suppression
of Tuberculosis. A physician is delegated by the League and one of the
regular Medical Inspectors of the city schools works in co-operation with
him.
Providence has at present two schools, with an attendance of forty. One
more Open Air School and two roof classes may be provided by the Board of
Education in 1914. In addition, the Providence League for the Suppression
of Tuberculosis conducts a Preventorium for thirty children at the
Lakeside Preventorium, Rhode Island.
* * * * *
Boston started its first Open Air School in July, 1908. The work was
carried on by the Boston Association for the Relief and Control of
Tuberculosis. The school was located at Parker Hill, Roxbury. The same
regime was followed as in previously reported schools. No formal
instruction, however, was attempted at first. The school was simply a day
camp. The benefit derived by the children in the first open air camp for
children led the Association to ask the Boston School Board to co-operate
with them in converting the camp into an outdoor school. This was agreed
to, the School Board supplying teacher, desks, books, etc., the
Association furnishing the necessary clothing, food, a nurse, attendants,
home instruction and medical services. The same schedule was followed here
as in the other Open Air Schools. General and personal hygiene was
insisted upon. The school was kept open Saturdays and during the holidays.
The children who were able paid ten cents a day to help defray the cost of
food. In case they could not afford this, the money was supplied by some
charity organization. While the combined public and private support had
proved satisfactory, it seemed best, for many reasons, to reorganize the
school so that it would be entirely under municipal authority, and this
has since been done. At the present time the school is maintained by the
Boston Consumptives' Hospital and the Boston School Board. The hospital
furnishes transportation, food, etc., while the School Board gives school
supplies, books, desks, etc., and pays the salaries of the teachers. The
children are selected by the school physicians, the type considered being
the anaemic, poorly nourished, those with enlarged glands, or
convalescents. Cases of active tuberculosis are not admitted.
Boston has at present fifteen Open Air Schools, with a total enrollment of
about 500 children.
* * * * *
The first school established in New York City was started under the
auspices of the Department of Education and was located on the ferryboat
Southfield, which was maintained as an outdoor camp for tuberculous
patients by Bellevue Hospital. It was through the special desire of the
children who were patients at the camp that the school was started, for
they banded together one day and informed the doctor that they wanted to
have a teacher and attend school. When their action was reported to the
Board of Education it was felt that such an unusual plea should be given a
favorable response, and in December, 1908, the school on the ferryboat was
made an annex of Public School No. 14.
This school, except for its location, does not differ from other schools
of similar type. The Board of Education pays the teacher and furnishes the
school supplies. Food and clothing are supplied by the hospital. The
school is an ungraded one and the number of children taught by one teacher
averages thirty.
Four more Open Air Schools have since been established, three on
ferryboats and one on the roof of the Vanderbilt Clinic at West Sixtieth
street. Officially, all these schools are considered to be annexes of the
regular public schools.
In October, 1909, $6,500 was granted to the Board of Education by the
Board of Estimate and Apportionment for the purpose of remodeling rooms in
some of the public schools for use as Open Air Rooms. A special conference
was held in December of that year by medical and school authorities to
decide how best to remodel, furnish and equip these new rooms for this
purpose; also how the children should be chosen for these classes.
It was decided that the maximum number of children admitted to any one
open air classroom should not exceed twenty-five, the children to be
chosen by the director of the tuberculosis clinic nearest the school and
the school principal. No child was to be assigned to the room until the
parents' permission had been secured in writing. Children moving from one
district to another were to be followed up and cared for in the new
district. No special rule was adopted defining the physical condition
entitling the child to admission. Each case was to be considered
individually, and the only definite rule was that no open case of
tuberculosis should be admitted. The minimum temperature of the room was
50 degrees F. The rooms, wherever possible, were to be located on the
third floor. The first of these open air classes was established in April,
1910. Such popular interest was awakened by the inauguration of these
classes that, as a direct result, a special privilege was granted by the
Commissioners of Central Park permitting children of the kindergarten
classes of the public schools to pursue their studies in the open air in
Central Park.
At present New York has thirty-three Open Air Schools and Open Window
Rooms, with a total enrollment of at least 1,000.
* * * * *
Chicago's first Outdoor School for Tuberculous Children was inaugurated as
a result of the joint co-operation of the Chicago Tuberculosis Institute
and the Board of Education. This school was opened during the first week
of August, 1909, on the grounds of the Harvard School at Seventy-fifth
street and Vincennes Road. The Board of Education assigned a teacher to
the school and furnished the equipment, while the Tuberculosis Institute
supplied the medical and nursing service, selected the children and
provided the food.
Except during inclement weather, the children occupied a large shelter
tent in which thirty reclining chairs were placed. Meals were served in
the basement of the school building, where a gas range, cooking utensils
and tables were installed for this special purpose.
The nurse, who was assigned by the Tuberculosis Institute on half-time
attendance, visited the school each afternoon, took daily afternoon
temperatures, pulse and respiration, looked after the general physical
condition of the children, made weekly records of their gain or loss in
weight and did instructive work in the home of each pupil.
Of the thirty children selected, seventeen had pulmonary tuberculosis, two
had tubercular glands, and eleven were designated as "pre-tuberculous."
None of the children had passed to the "open" or infectious stage. On
admission two-thirds of the children showed a temperature of from 99 to
100.2 degrees.
The daily program was similar to that already described for the Providence
and Boston Schools. The school was kept open for a period of only one
month, with excellent results. During this time the thirty children made a
net gain of 115 pounds in weight, and at the close of the period
practically all of them showed a normal temperature, with their general
condition greatly improved.
It is needless to say that the experiment created a great deal of local
interest in the problem of better school ventilation. Those who had the
success of the movement most intimately at heart realized, however, that
the undertaking lacked the element of permanency and that the results
accomplished by it lacked that degree of conclusiveness which would attend
the same results if secured through the operation of an all-the-year-round
school.