THE TEACHER'S HEALTH
"Teachers, gentlemen, no less than pupils, have a heaven-ordained right
to work so adjusted that the highest possible physical condition shall
be maintained automatically." This declaration thundered out by an
indignant physician startled a well-meaning board of school directors.
The teacher's right to health was, of course, obvious when once
mentioned, and the directors concluded:
1. School conditions that injure child health also injure teacher
health.
2. Poor health of teacher causes poor health of pupil.
3. Poor health of pupil often causes poor health of teacher.
4. Adequate protection of children requires adequate protection of
their teachers.
5. Teachers have a right to health protection for their own sake
as well as for their children's sake.
Too little concern has hitherto been shown for the vitality of teachers
in private or public schools and colleges. Without protest, and without
notice until too late, teachers often neglect their own health at home
and at school,--recklessly overwork, undersleep, and undernourish; ruin
their eyes, their digestion, and their nerves. School-teachers are
frequently "sweated" as mercilessly as factory operatives. The time has
come to admit that a school environment which destroys the health of
the teacher is as unnecessary and reprehensible as an army camp that
spreads typhoid among a nation's defenders. A school curriculum or a
college tradition that breaks down teachers is as inexcusable as a gun
that kills the gunner when discharged. Experience everywhere else
proves that periodic physical examinations and health precautions, not
essays about "happy teachers--happy pupils," are indispensable if
teachers' health rights are to be protected.
Physical tests are imposed upon applicants for teachers' licenses by
many boards of education. In New York City about three per cent of
those examined are excluded for defects of vision, of hearing, of
probable endurance. Once a teacher, however, there is no further
physical examination,--no way of discovering physical incapacity,
nothing to prevent a teacher from exposing class after class to
pulmonary tuberculosis contracted because of overwork and
underventilation. The certainty of salary increase year by year and of
a pension after the twentieth year will bribe many a teacher to overtax
her own strength and to jeopardize her pupils' health.
Seldom do training schools apply physical tests to students who intend
to become teachers. One young girl says that before starting her normal
course she is going to the physician of the board of education for
examination, so as to avoid the experience of one of her friends, who,
after preparing to be a teacher, was rejected because of pulmonary
tuberculosis. During her normal course no examination will be
necessary. Overwork during the first year may cause pulmonary
tuberculosis, and in spite of her foresight she, too, may be rejected
four years hence.
The advantages of physical examination upon beginning and during the
courses that prepare one for a teacher are so obvious that but little
opposition will be given by prospective teachers. The disadvantages to
teacher and pupil alike of suffering from physical defects are so
obvious that every school which prepares men and women for teachers
should make registration and certification dependent upon passing a
satisfactory physical test. No school should engage a teacher who has
not good proof that she can do the required work without injury to her
own or her pupils' health. Long before physicians can discover
pulmonary tuberculosis they can find depleted vitality which invites
this disease. Headaches due to eye trouble, undernourishment due to
mouth breathing, preventable indigestion, are insidious enemies that
cannot escape the physical test.
Three objections to physical tests for teachers will be urged, but each
loses its force when considered in the light of general experience.
1. _A sickly teacher is often the most efficient teacher in a school or
a county._ It is true that some sickly teachers exert a powerful
influence over their pupils, but in most instances their influence and
their efficiency are due to powers that exist in spite of devitalizing
elements. Rarely does sickness itself bring power. It must be admitted
that many a man is teaching who would be practicing law had his health
permitted it. Many a woman's soul is shorn of its self-consciousness by
suffering. But even in these exceptional instances it is probable that
children are paying too dearly for benefits directly or indirectly
traceable to defects that physical tests would exclude.
2. _There are not enough healthy candidates to supply our schools._
This is begging the question. In fact, no one knows it is true. On the
contrary, it is probable that the teacher's opportunity will make even
a stronger appeal to competent men and women after physical soundness
and vitality are made conditions of teaching,--after we all believe
what leading educators now believe, that the highest fulfillment of
human possibilities requires a normal, sound body, abounding in
vitality.
3. _Examination by a physician, especially if a social acquaintance, is
an unnecessary embarrassment._ The false modesty that makes physical
examination unwelcome to many adults, men as well as women, is easily
overcome when the advantages of such examination are understood. It is
likewise easy to prove to a teacher that the loss of time required in
having the examination is infinitesimal compared with the loss of time
due to ignoring physical needs. The programme for school hygiene
outlined in Chapter XXVII, Part IV, assumes that state and county
superintendents will provide for the examination of teachers as well as
of pupils.
[Illustration: TEACHERS WILL PREFER PHYSICAL EXAMINATIONS TO
FORCED VACATIONS
Boston Society for Relief and Study of Tuberculosis]
Because the health of others furnishes a stronger motive for preventive
hygiene than our own health, it is probable that the general
examination of teachers will come first as the result of a general
conviction that unhealthy teachers positively injure the health of
pupils and retard their mental development. Children at school age are
so susceptible and imitative that their future habits of body and mind,
their dispositions, their very voices and expressions, are influenced
by those of their teachers. Experts in child study say that a child's
vocal chords respond to the voices and noise about him before he is
able to speak, so that the tones of his voice are determined before he
is able to express them. This influence is also marked when the child
begins to talk. Babies and young children instinctively do what adults
learn not to do only by study,--follow the pitch of others' voices. Can
we then overestimate the effect upon pupils' character of teachers who
radiate vitality?
The character and fitness, aside from scholarship, of applicants for
teachers' licenses are now subjected by the board of examiners of New
York City to the following tests:
1. Moral character as indicated in the record of the applicant as
a student or teacher or in other occupation, or as a participant
in an examination.
2. Physical fitness for the position sought, reference being had
here to all questions of physical fitness other than those covered
in a physician's report as to "sound health."
3. Satisfactory quality and use of voice.
4. Personal bearing, cleanliness, appearance, manners.
5. Self-command and power to win and hold the respect of teachers,
school authorities, and the community.
6. Capacity for school discipline, power to maintain order and to
secure the willing obedience and the friendship of pupils.
7. Business or executive ability,--power to comprehend and carry
out and to accomplish prescribed work, school management as
relating to adjustment of desks, lighting, heating, ventilation,
cleanliness, and attractiveness of schoolroom.
8. Capacity for supervision, for organization and administration
of a school, and for the instructing, assisting, and inspiring of
teachers.
These tests probably exclude few applicants who should be admitted.
Experience proves that they include many who, for their own sake and
for children's sake, should be rejected. The moral character, physical
fitness, quality of voice, personal bearing, self-command, executive
ability, capacity for supervision, are qualities that are modified by
conditions. The voice that is satisfactory in conference with an
examiner may be strident and irritating when the teacher is impatient
or is trying to overcome street noises. On parade applicants are
equally cleanly; this cannot be said of teachers in the service, coming
from different home environments. Self-command is much easier in one
school than in another. Physical fitness in a girl of twenty may,
during one short year of teaching, give way to physical unfitness.
Therefore the need for _periodic tests_ by principal, superintendent,
and school board, _to determine the continuing fitness_ of a teacher to
do the special task assigned to her, based upon physical evidence of
her own vitality and of her favorable influence upon her pupils' health
and enjoyment of school life. Shattered nerves due to overwork may
explain a teacher's shouting: "You are a dirty boy. Your mother is a
dirty woman and keeps a dirty store where no decent people will go to
buy." A physical examination of that unfortunate teacher would probably
show that she ought to be on leave of absence, rather than, by her
overwork and loss of control, to cause the boys of her class to feel
what one of them expressed: "Grandmother, if she spoke so of my mother
I would strike her."
Just as there should be a central bureau to count and correct the open
mouths and closed minds that clog the little old red schoolhouse of the
country, so a central bureau should discover in the city teacher as
well as in the country teacher the ailments more serious than
tuberculosis that pass from teacher to pupil; slovenliness, ugly
temper, frowning, crossness, lack of ambition, cynicism,--these should
be blackballed as well as consumption, contagious morphine habit, and
contagious skin disease. Crooked thinking by teacher leads to crooked
thinking by pupil. Disregard of health laws by teacher encourages
unhygienic living by pupils. A man whose fingers are yellow, nerves
shaky, eyes unsteady, and mind alternately sleepy and hilarious from
cigarettes, cannot convey pictures of normal, healthy physical living,
nor can he successfully teach the moral and social evils of nicotinism.
Both teacher and pupil have a right to the periodic physical
examination of teachers that will give timely warning of attention
needed. Until there is some system for giving this right to all
teachers in private, parochial, charitable, and public schools, we
shall produce many nervous, acrid, and physically threadbare teachers,
where we should have only teachers who inspire their pupils with a
passion for health by the example of a good complexion, sprightly step,
bounding vitality, and forceful personality born of hygienic living.
PART III. COÖPERATION IN MEETING HEALTH OBLIGATIONS
CHAPTER XVI
EUROPEAN REMEDIES: DOING THINGS AT SCHOOL
Recently I traveled five hundred miles to address an audience on
methods of fitting health remedies to local health needs. I told of
certain dangers to be avoided, of results that had always followed
certain remedies, of motives to be sought and used, of community ends
to seek. Not knowing the local situation, I could not tell them exactly
what to do next, or how or with whom to do it; not seeing the patient
or his symptoms, I did not diagnose the disease or prescribe medicine.
Several members of the audience who were particularly anxious to start
a new organization on a metropolitan model were disappointed because
they were told, not just how to organize, but rather how to find out
what sort of organization their town needed. They were right in
believing that it was easier to copy on paper a plan tried somewhere
else, than to think out a plan for themselves. They had forgotten for
the time being their many previous disappointments due to copying
without question some plan of social work, just as they copy Paris or
New York fashions. They had not expected to leave this meeting with the
conviction that while the _ends_ of sanitary administration may be the
same in ten communities, health _machinery_ should fit a particular
community like a tailor-made suit.
American-like, they had a mania for organization. I once heard an aged
kindergartner--the savant of an isolated German village--describe my
fellow-Americans as follows: "Every American belongs to some
organization. The total abstainers are organized, the brewers are
organized, the teachers are organized, the parents are organized, the
young people and even the juniors are organized. Finally, those who
belong to no organization go off by themselves and organize a society
of the unorganized." Love of organization and love of copying have
given us Americans a feverish desire for what we see or read about in
Europe. When we talk about our European remedies we try to make
ourselves believe that we are broad-minded and want to learn from
others' experience. In a large number of cases our impatient demand for
European remedies is similar to the schoolboy's desire to show off the
manners, the slang, or the clothes picked up on his first visit away
from home. With many travelers and readers European remedies or
European ways are souvenirs of a pleasant visit, to be described like a
collection of postal cards, a curious umbrella, a cane associated with
Alpine climbing, or a stolen hymnal from an historic cathedral.
Experience proves, however, that just as Roman walls and Norman castles
look out of place in New York and Kansas, so European laws and European
remedies are too frequently misfits when tried by American schools,
hospitals, or city governments. Yesterday a Canadian clergyman, after
preaching an eloquent sermon, met a professional beggar on the street
in New York City and emptied his purse--of Canadian money! Quite like
this is the enthusiastic demand of the tourist who has seen or read
about "the way it's done in Germany." The trouble is that European
remedies are valued like ruins, by their power to interest, by their
antiquity or picturesqueness, or, like the beggar, by their power to
stimulate temporary emotion. But we do not sleep in ruins, go to
church regularly in thirteenth-century abbeys, or live under the
remedies that fire our imagination. We do not therefore see their
everyday, practical-result side.
The souvenir value of European remedies is due to the assumption that
no better way was open to the European, and that the remedy actually
does what it is intended to do. Because free meals are given at school
to cure and prevent undernourishment, it is taken for granted that
undernourishment stops when free meals are introduced; therefore
America must have free meals. Because it is made compulsory in a
charming Italian village for every child to eat the free school meal,
it is taken for granted that the children of that village have no
physical defects; therefore let Kansas City, Seattle, and Boston
introduce compulsory free meals. But when one goes to Europe to see
exactly how those much-advertised, eulogized remedies operate from day
to day, it is often necessary to write, as did a great American
sanitarian recently, of health administration in foreign cities
continually held up as models to American cities: "In spite of the
rules and theories over here, the patient has better care in New York
City."
We have been asked of late to copy several very attractive European
remedies for the physiological ills of school children, and for the
physical deficiencies of the next generation of adults: breakfasts or
lunches, or both, at school for all children, rich as well as poor,
whether they want school nourishment or not; school meals for the poor
only; school meals to be given the poor, but to be bought by those who
can afford the small sum required; free eyeglasses for the poor, for
poor and well-to-do, for those who wish them, for those who need them
whether they want to wear eyeglasses or not; free dental care; free
surgical treatment; free rides and outings during summer and winter;
country children to visit the metropolis, city children to visit
country and village; free treatment in the country of all children
whose parents are consumptives; free rides on street cars to and from
school; city-owned street railways that will prevent congestion by
making the country accessible; city-built tenements to prevent
overcrowding, dark rooms, insufficient air and light; free coal, free
clothes, free rent for those whose parents are unable to protect them
properly against hunger and cold. Every one of these remedies is
attractive. Every one is being tried somewhere, and can be justified on
emotional, economic, and educational grounds, if we think only of its
purpose. Let us view them with the eyes of their advocates.
Would it not be nice for country children to know that toward the end
of the school year they would be given an excursion to the largest city
of their state, to its slums, its factories, parks, and art galleries?
They would grow up more intelligent about geography. They would read
history, politics, sociology, and civil government with greater
interest. They would have less contracted sympathies. They might even
decide that they would rather live their life in the spacious country
than in the crowded, rushing city.
City children, on the other hand, would reap worlds of physical benefit
and untold inspiration from periods of recreation and study in the
country, with its quiet, its greens and bronzes and yellows, its birds
and animals, its sky that sits like a dome on the earth, its
hopefulness. Winter sleigh rides and coasting would give new vigor and
ambition. Why spend so much on teaching physiology, geography, and
nature study, if in the end we fail to send the child where alone
nature and hygiene tell their story? Why tax ourselves to teach history
and sociology and commercial geography out of books when excursions to
the city and country will paint pictures on the mind that can never be
erased? What more attractive or more reasonable than appetizing, warm
meals, or cool salads and drinks for the boys and girls who carry
their little dinner pails and baskets down the long road where
everything runs together in summer and everything freezes in winter?
One needs little imagination to see the "smile that won't come off,"
health, punctuality, and school interest resulting from the school
meal.
Again, if children must have teeth filled and pulled, eyes tested and
fitted for glasses, adenoids and enlarged tonsils removed, surely the
school environment offers the least affrighting spot for the tragedy.
Thence goblins long ago fled. There courage, real or feigned, is
brought to the surface by the anxious, critical, competitive interest
of one's peers.
[Illustration: A SOUTH IRELAND ARGUMENT FOR "DOING THINGS"]
The economic defense of these remedies is many-sided. An English
drummer once instructed me during a railroad journey from southern to
northern Ireland. As we entered the fertile fields of Lord Dunraven's
estate near Athlone, I expressed sympathy for other countries
impoverished of soil, of wealth, and of thrift. My instructor replied:
"It would pay the government to bring them all to this land free once a
year, just to show them what they are missing." That his idea of an
investment is sound has been proved by railroads and land companies and
even by states, who give away excursions to entice settlers and buyers.
Ambition at almost any cost is cheaper than indifference to
opportunity. It would be cheaper for our American taxpayer to send
school children to city and country than to pay the penalty for having
a large number of citizens with narrow interests, unconscious of the
struggles and joys of their co-citizens. Free meals, free books, free
rides, free eyeglasses, are cheaper than free instruction for the
second, third, and sixth terms in studies not passed because of
physical defects,--infinitely cheaper than jails and almshouses, truant
officers and courthouses.
The demoralizing results of giving "something for nothing" did not
follow free schooling or free text-books. Perhaps they would not follow
the free remedies that we are asked to copy from Europe. In fact, the
word "free" is the wrong word. These remedies rather require
coöperation of parent with parent. It has demoralized nobody because
the streets are cleaned by all of us, country roads made by the
township, police paid for by taxes and not by volunteer subscription.
The man whose children do not need glasses or nourishment or operation
for adenoids would find it cheaper to pay for European remedies than
for the useless schooling of boys unable to get along in school because
of removable defects. An unruly, uninterested boy sitting beside your
boy in public school, a pampered, overfed, undisciplined child sitting
beside yours at private school, is taxing you without your consent and
doing your child injury that may prove irreparable.
It costs $2.50 to furnish a child with eyeglasses. It costs $25 to $50
to give that child a year's schooling. If the child cannot see right
and fails in his studies, we have lost a good investment and, after one
year so lost, we are out $22.50. In two years we have lost $47.50. But,
what is more serious, we have discouraged that boy. Used to failure in
school, his mind turns to other things. He is made to think that it is
useless for him to try for first place. Perhaps he can play ball, and
excels. He chooses a career of ball playing. Valuable years are lost.
Initiative and competition are not interrupted any more by free
eyeglasses and free operation for adenoids than by free schooling.
There is only one place in the world where there is less competition or
less struggle than among the ignorant, and that is among the ignorant
and unwell. The boy who can't see the blackboard, who can't learn to
spell, who can't breathe through his nose, and can't be interested,
doesn't compete at all with the bright, healthy boy. Remove the
adenoids, give glasses, make interest possible, and fitness to survive
takes a higher level because larger numbers become fit to survive.
Professor Patten says that it is easier to support in the almshouse
than in competitive industry a man who cannot earn more than $1.50 a
day. The question, therefore, regarding European remedies is not, To
what general theory do they belong? but, What will they accomplish? How
do they compare with other remedies of which we know?
CHAPTER XVII
AMERICAN REMEDIES: GETTING THINGS DONE
In New York City there is a committee called the Committee on the
Physical Welfare of School Children. The word "welfare" was used rather
than "condition" because the committee proposed to use whatever facts
it could gather for the improvement of home and school conditions
prejudicial to child welfare. The following programme was adopted:
1. _Study of the physical welfare of school children._
a. Examination of board of health records of children needing
medical, dental, or ocular care, and better nourishment.
b. Home visitation of such children, in order to ascertain
whether their need arises from deficient income or from other
causes.
c. Effort to secure proper treatment, either from parents or
from free clinics or other established agencies.
d. Effort to secure proper physical surroundings of children
while at school--playgrounds, baths, etc.
2. _Effort to secure establishment of such a system of school
records and reports_ as will disclose automatically significant
school facts,--e.g. regarding backward pupils, truancy,
regularity of attendance, registered children not attending,
sickness, physical defects, etc.
3. _Effort to utilize available information regarding school needs_
so as to stimulate public interest and thus aid in securing
adequate appropriations to meet school needs.
The committee grew out of the discussion, in the year 1905, of the
following proposition: _To insure a race physically able to receive our
vaunted free education, we must provide at school free meals, free
eyeglasses, free medical and dental care._ Thanks to the
superintendent of schools of New York City, to Robert Hunter's
_Poverty_, to John Spargo's _Bitter Cry of the Children_, hundreds of
thousands of American citizens were made to realize for the first time
that a large proportion of our school children are in serious need of
medical, dental, or ocular attention, or of better nourishment.
Because physicians, dentists, oculists, hospitals, dispensaries, relief
agencies, had seemingly been unconscious of this serious state of
affairs, they had no definite, constructive remedy to propose. Their
unpreparedness served to strengthen the arguments for the European
method of _doing things_. France, Germany, Italy, England, had found it
necessary to do things at school. Arguing from their experience, it was
only a matter of time when American cities must follow their example.
Why not, therefore, begin at once to deal radically with the situation
and give school meals, school eyeglasses, etc.? Those who organized the
Committee on the Physical Welfare of School Children realized the
danger of trying to settle so great a question with the little definite
information then available. If _doing things at school_ were to be
adopted as a principle and logically carried out, vast sums must be
added to the present cost of the public school system. Complications
would arise with private and parochial schools, whose children might
have quite as serious physical defects, even though not educated by
public funds. It would be difficult to obtain proper rooms for medical
and dental treatment and meals, and perhaps still more difficult to
insure proper food, skilled oculists, dentists, surgeons, and
physicians. No one was clear as to how the problem was to be solved by
small cities and rural districts, whose needy children are no less
entitled to public aid simply because their numbers are smaller. Great
as were the difficulties, however, the committee saw that difficulties
are in themselves no reason for not doing the right thing. On the
other hand, if doing things at school is wrong, if school meals fail to
correct and remove physical defects, great social and educational wrong
would result from New York's setting an example that would not only
misdirect funds and attention in that city, but would undoubtedly lead
other cities to move in the wrong direction. Right could be hastened,
wrong could be prevented more effectually by facts than by any amount
of theory. School meals had been made a political issue in England. The
arguments supporting them were stronger than any possible arguments
against them, except proof that they would be less effective in helping
children than other means that might be proposed. If the American
people must choose between sickly, unteachable, dull children without
school meals, on the one hand, and bright, teachable, healthy children
plus school meals, on the other hand, they will not hesitate because of
expense or eighteenth-century objections to "socialism."
During one year of investigation and of _getting things done_ the
committee has prepared three studies for publication: (1) a report on
the home conditions of fourteen hundred school children of different
nationalities, found by school physicians to have defects of vision,
breathing, hearing, teeth, and nourishment; (2) an examination of fifty
schools--curriculum, buildings, home-study requirements, play space and
playtime, physical culture--in an attempt to answer the question, How
far does school environment directly cause or aggravate physical
defects of school children; (3) a comparative study of methods now
employed in a hundred cities to record, classify, and make public
significant school facts.
The results of the first year's work prove conclusively that physical
defects are not caused solely by the inability of parents to pay for
proper food. Among the twenty significant facts reported by the
committee are the following:
1. Physical defects found in public schools are, for the most
part, such as frequently occur in wealthy families and do not of
themselves presume as the cause insufficient income. Of 145
reported for malnutrition, 44 were from families having over $20
weekly.
2. Few of the defects can be corrected by nourishment alone;
plenty of fresh air, outside nourishment at school, or extra
nourishment at home will not entirely counteract the influences of
bad ventilation and bad light in school buildings. Country
children have adenoids, bad teeth, and malnutrition. Plenty of
food will not prevent bad teeth and bad ventilation from causing
adenoids, enlarged tonsils, and malnutrition.
3. Children whose parents have long lived in the United States
need attention quite as much as the recent immigrant.
4. A large part of the defects reported could be produced by
conditions due directly to neglect of teeth.
From twenty such statements of fact and from its experience in _getting
things done_ for one year, the committee drew fifteen practical
conclusions, among which the following deserve emphasis here:
1. The only new thing about the physical defects of school
children is not their existence, but our recent awakening to their
existence, their prevalence, their seriousness if neglected, and
their cost to individual children, to school progress, to
industry, and to social welfare.
2. _Physical deterioration_, applied to America's school children,
is a misnomer. No evidence whatever has been given that the
percentage of children suffering from physical defects in 1907 is
greater than the percentage of children suffering from such
defects in 1857. On the contrary, the small proportion of defects
that are not easily removable, as well as a vast amount of
evidence from medical experience and vital statistics, indicates
that, if a comparison were possible, the children of 1907 would be
found to have sounder bodies and fewer defects than their
predecessors of fifty years ago. If there is an exception to this
statement, it is probably defects of vision, with regard to which
school authorities and oculists seem to agree that confinement in
school for longer hours and more constant application under
unfavorable lighting conditions have caused a marked increase.
Positive evidence as to tendencies will be easily obtained after
thorough physical examination has been carried on for a
generation.
3. The effect of massing facts as to physical defects of school
children should not be to cause alarm, but to stimulate remedial
and preventive measures, to invoke congratulations and aggressive
optimism, not doleful pessimism and palliative measures born of
despair.
4. The causes of physical defects are not confined to "marginal"
incomes, but, while more apt to be present in families having
small incomes, are found among all incomes wherever there exist
bad ventilation, insufficient outdoor exercise, improper light,
irregular eating, overeating, improper as well as insufficient
food, lack of medical, dental, and ocular attention.
5. Whatever may be said of free meals at school as a means of
insuring punctual attendance or better attention, they are
inadequate to correct physical conditions that home and street
environment produce.
6. _To remove physical defects, causal conditions among all income
classes should be treated, and not merely symptoms revealed at
school by children of the so-called poor._
7. Parents can and will correct the greater part of the defects
discovered by the physical examination of school children, if
shown what steps to take. Where parents refuse to do what can be
proved to be within their power, and where existing laws are
nonenforced or inadequate, the segregation of children having
physical defects in special classes might prove an effective
stimulus to obstinate parents.
8. Where parents are unable to pay for medical, dental, and ocular
care and proper nourishment, private philanthropy must either
provide adequately or expect the state to step in and assume the
duty.
9. Private dispensaries and hospitals must either arrange
themselves to treat cases and to educate communities as to the
importance of detecting and correcting physical defects, or must
expect the state to provide hospital and dispensary care. Until
private hospitals and dispensaries take steps to prevent people
with adequate incomes from imposing upon them for free treatment,
it is difficult to make out a case against free eyeglasses and
free meals for school children.
10. Either private philanthropy or the state must take steps to
procure more dental clinics and an educational policy on the part
of the dental profession that will prevent the exploitation of the
poor when dental care is needed.
11. The United States Bureau of Education is the only agency with
authority and equipment adequate to secure from all sections of
the country proper attention to the subject. Nothing in the world
can prevent free meals, free eyeglasses, free medical care, free
material relief at school, unless educational use is made by each
community of the facts learned through physical examination to
correct home, school, and street conditions that produce and
aggravate physical defects. The national bureau can mass
information in such a way as to convince budget makers in city,
county, and state to vote gladly the funds necessary to promote
the physical welfare of school children.
[Illustration: THE DARK-HALL EVIL IS HERE INDEXED BY ADENOIDS.]
How the committee got things done is often referred to. There is
something about a request for coöperation, whether by schools or by any
other agency, that enlists the interest of those whose help is asked.
The reason is not that people are flattered by requests to serve on
committees, or that human nature finds it difficult to be unfriendly or
unkind. On the contrary, men and women are by nature social; there is
more joy in giving than in withholding, in working with others than in
working alone. Men and women, official and volunteer agencies, will
coöperate with school-teachers when invited, for the same reason and
with the same readiness that ninety-nine farmers out of a hundred, on
the prairie or in the mountain, will welcome a request for food and
lodging.
[Illustration: WHERE "GETTING THINGS DONE" IS POSSIBLE BUT
"DOING THINGS" INEFFECTIVE]
Mothers will naturally take a greater interest in the welfare of their
children if held responsible for proper food and proper home
surroundings than if not reminded of their responsibility. In New York
City a woman district superintendent of schools, Miss Julia Richman,
has organized a unique "social settlement." She and several
school-teachers occupy a house, known as "The Teachers' House." This is
their residence. Here they are subject to neither intrusion nor
importunity; no clubs or classes are held here; visitors are treated as
guests, not as beneficiaries. The purpose these teachers have in living
together is to work out the methods of interesting private and official
leaders in community needs disclosed at school.
Where clubs and social gatherings are held in school buildings, it is
not unusual for a thousand mothers, recent immigrants, to meet together
in one hall to hear talks on the care of children. Thus, instead of
principals, teachers, and physicians taking the place of mothers (which
they nowhere have succeeded in doing), they do succeed in harnessing
mothers to the school programme. It may take two, three, or ten visits
to get a particular mother to do the necessary thing for her child, but
when once convinced and once inspired to do that thing, she will go on
day in and day out doing the right thing for that child and for all
others in her home. It may take a year to convert a police magistrate
whose sympathy for delinquent parents and truant children is an active
promoter of disorder; but a magistrate convinced, efficient, and
interested is worth a hundred volunteer visitors. To get things done in
this way for a hundred thousand children costs less in time and money
than to do the necessary things for one thousand children.
CHAPTER XVIII
COÖPERATION WITH DISPENSARIES AND CHILD-SAVING AGENCIES
Scientists agree that the human brain is superior to the animal brain,
not because it is heavier, but because it is finer and better supplied
with nerves. As one writer has said, the human brain is better "wired,"
has better organized "centrals." A poor system of centrals will spoil a
telephone service, no matter how many wires it provides. An independent
wire is of little use, because it will not reach the person desired at
the other end. The ideal system is that which almost instantly connects
two persons, no matter how far away or how many other people are
talking at the same time on other wires.
The school that tries to do everything for its pupils without using
other existing agencies for helping children[10] will be like the man
who refuses to connect his telephone with a central switch board, or
like a bank that will not use the central clearing house. As one
telephone center can enable scores of people to talk at once, and as
one clearing house can make one check pay fifty debts, so hospital and
relief agencies enable a teacher who employs "central" to help several
times as many children as she alone can help.
[Illustration: ADEQUATE RELIEF RECOGNIZES THE FAMILY AS THE
UNIT]
It seems easier for a teacher to give twenty-five cents to a child in
distress than to see that the cause of the misery is removed. In New
York City there are over five hundred school principals, under them are
over fifteen thousand teachers, and the average attendance of children
is about six hundred thousand, representing one hundred and fifty
thousand homes. If teachers give only to those children who ask for
help, many will be neglected. In certain sections of the city
principals have combined to establish a relief fund to be given out to
children who need food, clothes, shoes, etc. One principal had to stop
replacing stolen overcoats because, when it was known that he had a
fund, an astonishingly large number of overcoats disappeared. At
Poughkeepsie school children get up parties, amateur vaudeville,
minstrel shows, basket picnics, to obtain food and clothing for
children in distress. They are, of course, unable to help parents or
children not in school. Of this method a district superintendent in New
York said to his teachers and principals: "For thirty-two years I have
been working in the schools of this district. I have given food and
shoes to thousands of children. I know that however great our interest
in a particular child when it comes to us with trouble at home, our
duty as teachers prevents us from following our gift into the home and
learning the cause of the child's trouble. This last winter we have
made an experiment in using a central society, which makes it a
business to find out what the family needs, to supply necessaries,
country board, medicine, etc. We now know that we can put a slip of
paper with the name and address of the child into a general hopper and
it will come out eyeglasses, food, rent, vacation parties, as the need
may be."
Relief at home through existing agencies was brought about by the
distribution of cards like those on opposite page, which offer winter
and summer coöperation.
[Illustration: FRESH-AIR AGENCIES LIKE SEA BREEZE PREFER TO AID
CHILDREN IN ORDER OF NEED]
[Illustration: (Facsimile of flyer for the New York Association
for Improving the Condition of the Poor.)]
+--------------------------------------------------------------------+
| =For School Children= |
| |
| Compulsory education implies the ability of all families, even the |
| poorest, to take advantage of school benefits. This means that |
| children should be fed properly, clad comfortably, and healthfully |
| housed. |
| |
| The New York Association for Improving the Condition of the Poor |
| aims to coöperate with school-teachers in every part of Manhattan |
| and The Bronx to insure comfort and prevent suffering among school |
| children, their parents, and younger brothers and sisters. On one |
| day last winter we received appeals from school principals and |
| teachers in behalf of twenty-nine families. Within six hours every |
| family was visited, emergent aid in food and coal provided for |
| many, and orders given for shoes and dresses and coats required by |
| the children of school age. During the winter we gave not only |
| clothing, groceries, food, and rent, but found work for older boys |
| and parents, taught mothers to prepare food properly, and sent a |
| visiting cleaner to make sick mothers comfortable and to get the |
| children ready for school. |
| |
| In a word, we followed that need, the surface evidence of which |
| comes to the attention of the teacher, back into the home and its |
| conditions, aiding throughout the period when the family was |
| unable to do justice by the school child. |
| |
| In many instances the home income was sufficient, but the home |
| management inefficient. Probably such homes could be more |
| effectively benefited through educational work emanating directly |
| from the school. |
| |
| We can be reached by telephone (348, 349, and 1873 Gramercy) from |
| 9 A.M. to 12 M. Letters or postal cards should be addressed to |
| Mrs. H. Ingram, Superintendent, 105 East 22d Street. Reference |
| slips will be gladly furnished upon application. |
| |
| The New York Association for Improving |
| 1843 * the Condition of the Poor * 1905 |
| |
| =Teachers of Manhattan and The Bronx= |
| |
| _Do you know of such children as these:_ |
| |
| 1. Convalescent children now out of school, who would be |
| benefited by a stay at the seashore in May or June? |
| |
| 2. Children in school whose anæmic condition would be |
| greatly improved by a week at Sea Breeze during July or |
| August? |
| |
| 3. Small brothers and sisters (and tired mothers) who may |
| need outings or special help? |
| |
| The New York Association for Improving the Condition of the |
| Poor will act promptly. Write or telephone (348 Gramercy). |
+--------------------------------------------------------------------+
When these cards were first distributed several teachers went from room
to room, asking children who needed help to raise the hand. In many
cases parents were very angry that their children should have asked for
help. But help given in instances like the following soon proved to
teachers that they could afford the time necessary to notice children
who appeared neglected, when so much good would ensue:
The father is sick and unable to work. They cannot get clothes for
the children, who are not attending school on that account.
Children were provided with shoes and clothes.
November 30, 1907, a school principal reported that six children
in one family needed underwear. A visitor discovered that one of
the boys who had the reputation of being unruly and light-fingered
also had adenoids. He was taken to a hospital for operation, and
was later interested in his school work.
A little girl was unruly and truant. No attempt was made to keep
her at school, but she was reported to the Committee on the
Physical Welfare of School Children. The parents could not control
her. The girl was taken for examination by a specialist and found
to be feeble-minded. Later she was sent to a custodial institute.
Another little girl was nine years old, but could not talk. A
University Extension Society worker found that she was not kept at
school because it was too much trouble. The child was taken to a
physician who operated and corrected the tongue-tie.
A girl of twelve said she must stay home to "help mother." The
mother was found to be a janitress, temporarily incapacitated by
rheumatism. A substitute was provided until the mother was well,
and all the children were properly clad for school.
After the adenoid operations in a New York school that occasioned
the East Side riots of 1906, the physicians and principals who had
persuaded parents to permit the operations were fearful lest the
summer in unsanitary surroundings might make the demonstration
less complete. Over forty children in three parties were sent away
for the summer, where they had wholesome food and all the milk
they could drink and fresh air day and night. When they returned
in the fall the principal wrote: "The improvement in each
individual is simply marvelous. We shall try to continue this
condition and shall constantly urge the parents to keep up the
good work by means of proper food and fresh air."
In none of these instances could the teachers have accomplished equal
results for the individual children or for the families without
neglecting school duties. By informing other agencies as to children's
needs, teachers started movements that have since helped practically
every school child in New York City. Dispensaries are setting aside
separate hours for school children; fresh-air agencies are giving
preference to children found by teachers or school physicians to be in
physical need; relief agencies are making "rush orders" of every note
from teachers; the health board is more active because volunteer
agencies have added their voice to that of teacher and health officer
in demanding adequate funds for physical examination of school
children.
[Illustration: "CENTRAL" FOUND THE MOTHER SICK IN A HOSPITAL,
THE FATHER KILLED--THE CHILDREN WERE BOARDED IN THE COUNTRY
UNTIL THE MOTHER RECOVERED]
Coöperation is at present easier in New York than in any other city.
Charitable societies, hospitals, dispensaries, are probably more keenly
alive to their responsibilities and are at least more apt to have
acquired the habit of coöperation when asked. Yet even here I have been
told repeatedly by teachers: "If we have to wait for that hospital or
that charitable society, our children will go barefoot." In small
communities where hospital and relief agencies are for emergencies only
and generally inactive, it seems that the first thing to do is to ask
some friends to establish a small relief fund, just as it is easier to
give a child a five-cent meal than to teach its mother how to prepare
its food. But the school-teacher will find that it takes very much less
energy to arouse the relief society than to maintain her own relief
work. In fact, in many cities nothing could do more to strengthen
hospitals and charitable societies than to put them in touch with the
needs of school children. For a principal to make known the fact that
school children are neglected will help the charitable society and
hospital to get the funds necessary to do their part better than they
are now doing it and better than the school could ever do it. Finally,
one reason for a breakdown of charitable societies is not their own
inadequacy, but rather the failure of the school and church to make
use of an agency better equipped than themselves to give material
relief. The teacher sees the child every day, while the relief society
will never see it and has no reason to see it until some one calls
attention to it. The very first step, and an indispensable one in
relief policy, is for teachers to be on the lookout for children not
adequately provided for, and then have the physical evidence discovered
at school followed to the home for the cause of the child's distress.
[Illustration: HOME-TO-HOME INSTRUCTION IN COOKING
Anæmic condition of child due to bad cooking, not to lack of
income]
_Coöperation_ removes the cause of distress; _doing_ may aggravate it.
Teachers would do well to draw up for themselves a chart which will
show exactly what part of the community's work can be best done by
their school. On the following page is charted the social work now
being conducted at the Massachusetts General Hospital, Boston. So far
as agencies exist to deal with any individual or family problem coming
into the social-work square, the hospital aims to utilize that agency.
Its own direct dealing with neurasthenics, with hygiene education, with
sexual deviates, is primarily for the purpose of giving adequate
treatment to the needy, and secondarily to demonstrate how adequate
treatment should be organized for the community. Please to note that
governmental agencies are not mentioned in Dr. Cabot's chart. This does
not mean that he would not emphasize the importance of those agencies,
but that up to the present time, for the particular cases dealt with in
his clinics, governmental agencies can be reached most effectively
through the private charitable agencies in the reference square. So the
teacher will frequently find that the relief bureau, children's
society, public education association, or church can get better results
for her pupils from public health and correctional agencies than can
she by writing directly.
[Illustration: CHART OF SOCIAL WORK, MASSACHUSETTS GENERAL HOSPITAL]
+-----------------------------------+
| _Work for the Tuberculous_ |
| |
| 1. Tuberculosis classes |
| 2. Reference to other agencies |
| 3. Examination of children |
| 4. Stimulation of suburbs |
+-----------------------------------+
|
|
|
+--------------------------------+ | +--------------------------------+
| _Psychiatric Work_ | | | _Work for Hygienic Conditions_ |
| | | | |
| 1. For neurasthenics and | | | 1. Individual instruction |
| hysterics | | | 2. Convalescent homes |
| 2. For defectives | | | 3. Industrial hygiene |
| 3. For stammerers | | | 4. Home hygiene |
| 4. For epileptics | | | |
+--------------------------------+ | +--------------------------------+
\ | /
\ | /
\ | /
\ | /
\ | /
\ | /
\ | /
+-----|-----+
| |
/SOCIAL WORK\
/| M.G.H. |\
/ +---/|\-----+ \
/ / | \ \
/ / | \ \
/ / | \ \
/ / | \ \
+-------/-----|-----\-------\---+
| _References to Other Agencies_|
| |
/|1. Hospitals and sanatoriums |
/ |2. Associated charities |\
/ |3. Societies for children | \
/ |4. District and visiting nurses| \
/ |5. Settlements | \
/ |6. Homes--temporary or not | \
/ /|7. Employment agencies | \
/ / +-------------|-----------------+ \
+------------/-----/----+ | +--\-------\----------+
| _Ward Work_ | | | |
| | | | _Work for |
| 1. With cases soon to | | | Cases of |
| be discharged | | | Varicose Ulcer_ |
| 2. Cases needing | | | |
| friendly offices | | | |
+-------------/---------+ | +---------\-----------+
/ | \
+-----------/-----------+ | +--------------\----------+
| _Work for | | | _Assistance to M.G.H._ |
| Sexual Deviates_ | +---------|---------+ | Financial investigation |
| | | _Assistance to | | |
| 1. Unmarried but | | Other Agencies_ | |(a) of Cases asking free |
| pregnant | | | | treatment |
| 2. Diseased | | 1. Steering cases | |(b) of Cases presumably |
| 3. Exposed | | 2. Coöperation | | able to pay a physician |
+-----------------------+ +-------------------+ +-------------------------+
In country districts no plan has yet been worked out for adequate
relief. Fortunately, however, the distress is generally of such a kind,
and the teacher so well acquainted with all the parents of her
district, that it will not be difficult to procure such attention as is
necessary. Country schools should be furnished by county and state
superintendents with clear directions for getting the treatment
afforded in the immediate vicinity. Where teachers are alone in seeing
the need for coöperation they can quickly interest young and old,
physicians, dentists, pastors, health officers, in home visiting,
street cleaning, nursing, helping truants, needed changes of
curriculum, etc. _Getting things done_ is easy because it is human to
love the _doing_; getting things done is _doing_ of the highest order.
FOOTNOTES:
[10] The importance of recognizing the family as the unit of social
treatment is presented in Edward T. Devine's _Principles of Relief_, and
in Homer Folks's _Care of Dependent, Defective, and Delinquent
Children_.
CHAPTER XIX
SCHOOL SURGERY AND RELIEF OBJECTIONABLE, IF AVOIDABLE
The popular arguments for free meals, free relief, free medical
treatment at school, are based upon the assumption that there are but
two ways to travel, one leading to a physically sound, moral, teachable
child, the other to an undernourished, subnormal, backward child. They
tell us we must choose either school meals or malnutrition, school
eyeglasses or defective vision, free coal or freezing poor, free rent
or people sleeping on the streets, free dental clinics at school or
indigestion and undernourishment, free operation at school for adenoids
or backward, discouraged pupils. If there is no other alternative than
neglect of the child, if we must either waste fifty dollars in giving a
child education that he is physically unable to take, or pay two,
three, four, or even fifty dollars to fit him for that education, the
American people will not hesitate. Whether there are other roads to
healthy children, whether it is cheaper and better for the school to
see that outside agencies prepare the child for education rather than
itself to take the place of those outside agencies, is a question of
fact, not of theory.
Facts prove, as we have seen, that there is more than one way to
prevent malnutrition. Parents can be taught to attend to their
children; hospitals and dispensaries will furnish eyeglasses where
parents are unable to pay for them; charitable societies will go back
of the need for eyeglasses to the conditions that produce that need and
will do vastly more for the child than can eyeglasses alone. If
parents, hospitals, dispensaries, and charitable societies will attend
to children's needs, then relief at school is unnecessary, even though
it may seem desirable.
The objection to school surgery should be clearly before us, so that we
can judge of the two methods that are open to us,--_treatment at
school_ vs. _treatment away from school_.
Society is so organized that the treatment of serious physical defects
and social needs at school would upset the machinery a very great deal.
For the school to do for its children whatever they may need during
their school years will require the setting up of a miniature society
in every school building or under every school board. Unless schools
are to equip themselves to take the place of all existing facilities
for relief and surgery, children would not be so well taken care of as
at present. It should not be forgotten that the physical welfare of the
school child is the most accurate index to the physical needs of the
community. After all, the child lives for six important years before
coming to the school and leaves at the early age of fourteen or
fifteen; even while attending school it sleeps at home and is
influenced more by home and street standards of ventilation,
cleanliness, and morality than by conditions at school. It would seem,
therefore, the wider use of the school's influence to use the child's
appeal to strengthen every agency having to do with community health,
rather than to concentrate upon the child himself. If babies were
properly cared for up to the sixth year, the protection of the school
child's health would be infinitely easier. To take our eyes from the
child not yet in school and from the child just out of school is to
make the mistake that so many advocates of the child labor movement
have made of going whither and only so far as our interest leads us and
of not continuing until our work is accomplished.
[Illustration: "DOING THINGS" THROUGH MODEL TENEMENTS]
Do we want to make of our schools miniature hospitals, dispensaries,
relief bureaus, parks? Or shall we use the momentum of society's
interest in the school child to put within the reach of every school
building adequate hospitals, dispensaries, relief centers, and parks
for school child and adult? Shall every little school have its library,
or shall the child be taught at school how to use the same library
that is available to his parents and older brothers and sisters? If
the library is to be under the school roof, if dispensary and relief
hospital are to be conducted on the same site as the school, shall they
be known as dispensary, library, relief bureau, each under separate
management, or shall they be known as school under the management of
school principal and superintendent? So complicated and many-sided is
the problem of working together with one's neighbor for mutual benefit
that it is a safe rule for the schools to adopt: _We shall do nothing
that is unnecessary or extravagant. We shall have done our part if we
do well what no one else can do. Whatever any agency can do better than
we, we shall leave to that agency. Work that another agency ought to
have done and has left undone, we shall try to have done by that
agency._
[Illustration: IMMEDIATELY OPPOSITE THE MODEL TENEMENTS, BUT
UNINFLUENCED
"Getting things done" by the Tenement House Department their
special need]
I know a hospital where a welfare nurse was recently employed. Within a
few blocks were three different relief agencies and two
visiting-nurse's associations, having among them over one hundred
visitors and nurses going to all sections of Manhattan. This nurse had
the choice of telephoning to one of these agencies and asking it to
call at the needy home of one of her hospital patients, or of going to
the home herself. Had she chosen to use another agency, she could have
been the means of furnishing the kind of help needed in every needy
home discovered in her hospital rounds, but she chose to do the running
about herself and thus of helping ten families where she ought to have
helped five hundred. Much the same condition confronts the school that
tries to do all extra work for its child instead of seeing that the
work is done. Illustration is afforded by the New York tenement
department. Whereas European cities have built a few model tenements,
New York City secured a law declaring that everybody who built a
tenement and everybody who owned a tenement should provide sanitary
surroundings. At the present time a philanthropist, by spending two
million dollars, could give sanitary surroundings to thirty-five
families; by spending each year the interest on one tenth that sum he
could insure the enforcement of the tenement laws affecting every
tenement resident in New York City.
If schools are to perform surgical operations, they are in danger of
being sued for malpractice; discipline will be interfered with.
Finally, let us not forget that we are dealing with buildings,
teachers, and school institutions as they exist. Where education is
made compulsory, the unpleasant and the controversial should be kept
out of school. Because a democratic institution, the American school
should represent at all times a maximum of general agreement.
To take _palliative measures to public schools_ not only _leaves undone
remedial_ work necessary for the health of public school children but
_neglects entirely the still large numbers who go to parochial, private
pay, and private free schools_; no one has had the temerity to suggest
that the public shall force upon nonpublic schools a system of free
operations, free eyeglasses, free meals.
Civilization has painstakingly developed a large number of agencies for
the education and protection of mankind. Of these agencies the school
is but one. Its first and peculiar function is _to teach and to train_.
This it can do better than any other agency or combination of agencies.
In attempting to "bring all life under the school roof," we use but a
small part of our resources. Instead of persuading each of the agencies
for the promotion of health to do its part for school children, we set
up the school in competition with them. Thus in trying to _do things_
for school children we are in danger of crippling agencies equipped to
do things for both school children and their parents, for babies before
they come to school, and for wage earners after they leave school.
_Getting things done_ will lead schools to study underlying causes;
_doing things_ has heretofore caused schools to confine themselves to
symptoms. _Getting things done_ will leave the school free to
concentrate its attention upon school problems; _doing things_ will
lead it afield into the problem of medicine, surgery, restaurant
keeping, and practical charity.
CHAPTER XX
PHYSICAL EXAMINATION FOR WORKING PAPERS
There is no sacred right to work when our work involves injury to
ourselves and to our neighbor. Work at the expense of health is an
unjustifiable tax upon the state. It is the duty of society to protect
itself against such depletion of national efficiency.
Three classes of workmen need special attention: (1) those who are
physically unfit to work; (2) those who are physically unfitted for the
work they are doing; (3) those who are subjected to unhealthful
surroundings while at work. Viewing these three classes from the
standpoint of their neighbors, we have three social rights that should
be enforced by law: (1) the right to freedom from unhealthy work; (2)
the right to work fitted to the body; (3) the right to healthy
surroundings at work.
It is undoubtedly true that just as the sick child may be found at the
head of his class, so unhealthy men and women are often good business
managers, good salesmen, good typewriters, successful capitalists. They
excel, however, not because of their ill health, but in spite of it,
excepting of course those instances where men and women, because of ill
health, have devoted to business an attention that would have been
given to recreation if bad health had not deprived recreation of its
pleasure. As statistics in school have proved that the majority of
mentally superior children are also physically superior, so statistics
will probably prove that the number of the "sick superior" among the
working classes is very small, while the danger of inefficiency that
comes from physical defect is very great.
There is one time in the individual's working life when the state may
properly step in and demand an inventory of physical resources, and
that is when the child asks the state for permission to go to work.
Strategically, this is probably the most important of all contact as
yet provided between society and the future wage earner. Here at the
threshold of his industrial career the boy may be told for what work he
is physically fitted, what physical defects need to be remedied, what
physical precautions he needs to take, in order to do justice to
himself and his opportunity.
Every year from two to three million children leave the public schools
of this country to join the army of workers. The percentage of those
recruits who have physical defects needing attention is undoubtedly
great; how great we shall never know until the benefits of physical
examination are given to all of them. What steps is your state taking
to ascertain the physical fitness of the children who present
themselves each year for working papers? How does it insure itself
against the risk of their defective eyesight, chorea, deafness, or
general debility? Does it inform children of their defects, or tell
them how they may increase their earning power by correcting these
defects? What effort does it make to induce children to avoid dangerous
trades, or trades that are particularly dangerous for their physiques?
At the close of school last spring I had my secretary look in upon the
New York board of health and see what demands that city makes upon its
boys and girls before allowing them to drive its machinery, to run its
elevators, to match its colors, to sew on its buttons, to set its type,
to carry its checks to the bank. The officer at the door of the room
where the children were being examined, greeted her as follows: "You
must bring your child with you; bring his birth certificate or swear
that he is fourteen years old, and bring a signed statement from his
teacher that he has been in school for one hundred and thirty
consecutive days within twelve months." "Is there no physical
examination or test?" she asked. "No, no," he answered impatiently. Yet
the board of health certifies that "said child has in our opinion
reached the normal development of a child of its age, and is in sound
health and is physically able to perform the work which it intends to
do." In addition the blank calls for place and date of birth, color of
hair and of eyes, height, weight, and facial marks. Volunteer societies
in practically every state in the Union have been working for years to
have it made a criminal offense to employ a child who has not been in
school a minimum of days after a stated age (12, 13, 14, 15). Even in
New York, however, the center of this agitation, no strong demand was
made upon the board of health to apply a physical-fitness test as well
as an age test until 1908 when examination for working papers was added
to the programme for child hygiene. Yet who does not know girls and
boys of sixteen less fit for factory or shop work than other boys and
girls of twelve? It is the fetich of age which has made possible the
"democracy" that permits a child of fourteen to work all day on
condition that he go to school at night!
[Illustration: CHILDREN ENLISTING IN THE INDUSTRIAL ARMY]
[Illustration: WAITING TO BE EXAMINED FOR WORKING PAPERS
An excellent opportunity for physical-fitness tests]
So great is the risk of defective, sickly, or intemperate employees,
that in some trades employers take every precaution to exclude them.
One man with defective eyesight or unsteady nerves may cost a railroad
thousands of dollars. As insurance companies rank trades as first-,
second-, or third-class risks, so many factories, from long experience,
debar men with certain characteristics which have been found
detrimental to business. The Interborough Rapid Transit Company of New
York City examines all applicants for employment, as to age, weight,
height, keenness of vision, hearing, color perception, lungs, hearts,
arteries, alcoholism, and nicotinism. Those who fall below the standard
are rejected, but in each case the physical condition is explained to
the applicant. Where defects are removable or correctable, the
applicant is told what to do and invited to take another test after
treatment. Moreover, accepted employees are periodically reëxamined.
While designed to increase company profits and to reduce company
losses, this examination obviously decreases the employees' losses
also, and increases the certainty of work and prospect of promotion.
Our states, and many of our industries, still have the attitude of a
certain manufacturer who employs several hundred boys and girls. I
asked him what tests he employed. "I look over a long line of the
applicants and say," pointing his finger, "I want you, and you, and
you; the rest may go." I asked him if he made a point of picking out
those who looked strong. "No. The work is easy, sitting down all day
long and picking over things. I select those whose faces I like. Yes,
there is one question we now ask of all the girls. One day a girl in
the workroom had an epileptic fit and it frightened everybody and upset
the work so that the foreman always asks, 'Do you have fits? Because if
you do, you can't work here.'" He makes no attempt to determine the
physical fitness and endurance of the children employed, because when
the strength of one is spent there is always another to step into her
place.
Because the apprentice's future is of no value to the manufacturer, the
state must restrict the manufacturer's freedom to spend like water
society's capital,--the health of the coming generation. Could there be
a grosser mis-management of society's business than to permit trade to
waste children on whose education society spends so many millions
yearly? The most effective and most timely remedy is physical
examination as a condition of the work certificate. A simple, easily
applied, inexpensive measure that imposes only a legitimate restriction
upon individual freedom, it is absolutely necessary in order to get to
the bottom of the child labor problem. If thoroughly applied, children
of the nation will no longer be exploited by unscrupulous or
indifferent employers, nor will their health be hazarded by lack of
discriminating examination that rejects the obviously sick and favors
the apparently robust. Furthermore, knowledge that this test will be
applied when work certificates are required, will be an incentive to
the school boy and girl to keep well. Tell a boy that adenoids or weak
lungs will keep him from getting a job, and you will make him a strong
advocate of operation and of fresh air. Show him that his employers
will not wish his services when his week is out if he is physically
below par, and he will gladly submit to a board of health examination
and ask to be told what his defects are and how to correct them.
[Illustration: CHILDREN AT WORK BELOW BOTH AGE LIMIT AND
VITALITY LIMIT
National Child Labor Committee]
Some there are who will object to this appeal to the child's economic
instinct. This objection does not remove the instinct. The normal child
is greedy for a job. His greed, as well as that of the manufacturer and
parent, is responsible for much of the child labor; his greed for
activity, for association, for money, and so for work. A little boy
came into my office and wanted to hire as an office boy. I looked at
him and said: "My little fellow, you ought to be in school. What do you
want to hire out here for?" He said, "I am tired of school; nothing
doing." He doesn't care about work for its own sake; he doesn't care
about wealth for its own sake; he wants to get into life; to be where
there is "something doing." In this lies one potent argument for
vocational training. To tell a boy of his physical needs just before he
has taken his first business step is to put him everlastingly in our
debt. Then he is responsive, and, fortunately for the extreme cases,
necessarily dependent, for he knows that his refusal would stand
between himself and his ambition.
When boys and girls go for work certificates to Dr. Goler, medical
officer of health at Rochester, he requires not merely evidence of age
and of schooling, but examines their eyes for defective vision and for
disease, their teeth for cavities and unhealthy gums, and their noses
and throats for adenoids and enlarged tonsils. If a boy has sixteen
decayed teeth, Dr. Goler explains to him that teeth are meant to be not
only ornaments and conveniences, but money getters as well. The boy
learns that decayed teeth breed disease, contaminate food, interfere
with digestion, make him a disagreeable companion and a less efficient
worker. If he will go and have them put into proper condition he will
enjoy life better and earn good wages sooner. After the teeth are
attended to the boy secures his work certificate. If the boy's mother
protests in tears or in anger that her boy does not work with his
teeth, she learns what she never learned at school, that sound teeth
help pay the rent. If a girl applicant for working papers has adenoids,
she is asked to look in the mirror and to notice how her lips fail to
meet, how the lower jaw drops, how much better she looks with her jaws
and lips together. She is told that other people breathe through the
nose, and that perhaps the reason she dislikes school and does not feel
as she used to about play is that she cannot breathe through her nose
as she used to. She is shown that her nose is stopped up by a spongy
substance, as big as the end of her little finger, which obstruction
can be easily removed. She is shown adenoids and enlarged tonsils that
have been removed from some other girl, and is so impressed with the
before-operation and after-operation contrast and by the story of the
other girl's rapid increase in wages, that she and her mother both
decide not to wait for the adenoids to disappear by absorption. After
the operation they come back with proof that the trouble is gone, and
get the "papers." Similar instruction is given when defects of vision
seriously interfere with a child's prospects of getting ahead in his
work, or when evidence of incipient tuberculosis makes it criminal to
put a child in a store or factory.
[Illustration: THE GRENFELL ASSOCIATION FINDS MOUTH BREATHERS AT
WORK IN LABRADOR]
No law as yet authorizes the health officer of Rochester to refuse work
certificates to children physically unfit to become wage earners. A
higher law than that which any legislature can pass or revoke, has
given Dr. Goler power over children and parents, namely, interest in
children and knowledge of the industrial handicap that results from
physical defects. This higher law authorizes every health officer in
the United States to examine the school child before issuing a work
certificate, to tell the child and his parents what defects need to be
removed, for what trades he is physically unfitted, what trades will
not increase his physical weakness, and to what trade he is physically
adapted.
We should not forget that a large proportion of our children never
apply for work certificates; some because they never intend to work;
some because they expect to remain in school until sixteen or later;
some because they live on farms, in small towns, or in cities and
states where prohibition of child labor is not enforced. Because there
is no reason for this large proportion of children to visit a board of
health, some substitute must be found. This substitute has been already
suggested by principals and district superintendents in New York City,
who claim that the natural place for the examination of children is the
school and not health headquarters. Developing the idea that the school
should pronounce the child's fitness to leave school and to engage in
work, we are led to the suggestion that the state, which compels
evidence that every child, rich or poor, is being taught during the
compulsory school age, shall also at the age of fourteen or sixteen
require evidence that the child is physically fit to use his education,
and that it shall not, because of preventable ill health, prove a
losing investment.
Parochial and private schools, the ultra-religious and ultra-rich, may
resent for a time public supervision of the physical condition of
children who do not ask for work certificates. This position will be
short-lived, because however much we may disagree about society's right
to control a child's act after his physical defects are discovered, few
of us will question the state's duty to tell that child and his
parents the truth about his physical needs before it accepts his labor
or permits him to go to college, to "come out," to "enter society," or
to live on an income provided by others. Thus an invaluable
commencement present can be given by the state to children in country
schools and to those compelled to drop out of fourth or fifth grades of
city schools.
[Illustration: THE HEALTH DEPARTMENT'S CLINICAL CARE AND HOME
INSTRUCTION COME AFTER WAGE LOSSES, WHILE WORK CERTIFICATES
PRECEDE BREAKDOWNS FROM TUBERCULOSIS]
A brief test of this method of helping children, such as is now being
made by several boards of health at the instance of the National Bureau
of Labor, will prove conclusively that parents are grateful for the
timely discovery of these defects which handicap because of their
existence, not because of their discovery. Of the cadets preparing for
war at West Point, it has recently been decided that those "who in the
physical examinations are found to have deteriorated below the
prescribed physical standard will be dropped from the rolls of the
academy." Shall not cadets preparing for an industrial life and
citizenship be given at least a knowledge of an adequate physical
standard? To allow the school child to deteriorate whether before or
after going to work is only to waste potential citizenship. Citizens
who use themselves up in the mere getting of a living have no surplus
strength or interest for overcoming incompetence in civic business, or
for achieving the highest aim of citizenship,--the art of
self-government for the benefit of all the governed.
CHAPTER XXI
PERIODICAL PHYSICAL EXAMINATION AFTER SCHOOL AGE
Governor Hughes, in his address to the students in Gettysburg College,
pleaded for such lives that strength would be left for the years of
achievement. How many men and women can you count who are squandering
their health bank account? How many do you know who are now physically
bankrupt? The man who is prodigal of his health may work along all
right for years, never realizing until the test comes that he is
running behind in his vitality. The test may be hard times, promotion,
exposure to cold, heat, fever, or a sudden call for all his control in
avoiding accident. If his vitality fails to stand the test, his career
may be ruined, "all for the want of a horseshoe nail": because of no
health bank account to draw upon in time of need,--failure; because of
vitality depleted by alcohol, tobacco, overeating, underexercise, or
too little sleep,--no power to resist contagious diseases; because of
ignorance of existing lung trouble,--a year or more of idleness,
perhaps poverty for his family; or there is neglected ear or eye
trouble,--and thousands of lives may be lost because the engineer
failed to read the signals.
Adults are now examined when applying for insurance or accident
policies, for work on railroads, for service in the army and on the
police and fire forces of cities that provide pensions. It is somewhat
surprising that the hundreds of thousands who carry life insurance
policies have not realized that a test which is rigorously imposed for
business reasons by insurance companies can be applied by individuals
for business reasons. Generations hence the state will probably
require of every person periodic physical examination after school age.
Decades hence business enterprises will undoubtedly require evidence of
health and vitality from employees before and during employment, just
as schools will require such evidence from teachers. It is, after all,
but a step from the police passport to the health passport. Why should
we not protect ourselves against enemies to health and efficiency as
well as against enemies to order? But for the present we must rely upon
the intelligence of individuals to recognize the advantage to
themselves, their families, and their employers, of knowing that their
bodies do not harbor hidden enemies of vitality and efficiency. From a
semi-annual examination of teeth to a semi-annual physical examination
is but a short step when once its effectiveness is seen by a few in
each community.
[Illustration: THE OLD SOUTHFIELD, NOW ANCHORED AT BELLEVUE
HOSPITAL'S DOCK, NEW YORK CITY, GIVES DAILY LESSONS IN THE
PREVENTABLE TAX LEVIED BY TUBERCULOSIS]
Ignorance of one's physical condition is a luxury no one can afford. No
society is rich enough to afford members ignorant of physical
weaknesses prejudicial to others' health and efficiency. Every one of
us, even though to all appearances physically normal, needs the
biological engineer. New conditions come upon us with terrific
rapidity. The rush of work, noise, dust, heat, and overcrowding of
modern industry make it important to have positive evidence that we
have successfully adapted ourselves to these new conditions. Only by
measuring the effects of these environmental forces upon our bodies can
we prevent some trifling physical flaw from developing into a chronic
or acute condition. As labor becomes more and more highly specialized,
the body of the laborer is forced to readapt itself. The kind of work a
man does determines which organs shall claim more than their share of
blood and energy. The man who sets type develops keenness of vision and
manual dexterity. The stoker develops the muscles of his arms and back,
the engineer alertness of eye and ear. All sorts of devices have been
invented to aid this specialization of particular organs, as well as to
correct their imperfections: the magnifying glass, the telescope, the
microscope, extend the powers of the eye; the spectacle or an operation
on the eye muscles enables the defective eye to do normal work. A man
with astigmatism might be a policeman all his life, win promotion, and
die ignorant of his defect; whereas if the same man had become a
chauffeur, he might have killed himself and his employer the first
year, or, if an accountant, he might have been a chronic dyspeptic from
long-continued eye strain. It is a soul tragedy for a man to attempt a
career for which he is physically unadapted.[11] It is a social tragedy
when men and women squander their health. A great deal of the success
attributed to luck and opportunity, or unusual mental endowment, is in
reality due to a chance compatibility of work with physique. To secure
such compatibility is the purpose of physical examination after school
age.
If the periodic visit to the doctor is the first law of adult health,
still more imperative is the law that competent physicians should be
seen at the first indication of ill health. Even when competent
physicians are at hand, parents and teachers should be taught what
warning signs may mean and what steps should be taken. In Germany
insurance companies find that it saves money to provide free medical
and dental care for the insured. Department stores, many factories and
railroads, have learned from experience that they save money by
inducing their employees to consult skilled physicians at the first
sign of physical disorder. Many colleges, schools, and "homes" have a
resident physician. Wherever any large number of people are assembled
together,--in a hotel, factory, store, ship, college, or school,--there
should be an efficient consulting physician at hand. If people are
needlessly alarmed, it is of the utmost importance to show them that
there is nothing seriously wrong. Therefore visits to the consulting
physician should be encouraged.
The reader's observation will suggest numerous illustrations of pain,
prolonged sickness, loss of life, that could have been prevented had
the physician been semi-annually visited. A strong man, well educated,
with large income, personally acquainted with several of the foremost
physicians of New York City, after suffering two weeks from pains "that
would pass away," was hurriedly taken to a hospital at three o'clock in
the morning, operated upon immediately, and died at nine. A business
man of means put off going to a physician for fifteen years, for fear
he would be told that his throat trouble was tobacco cancer, or
incipient tuberculosis, or asthma; a physical examination showed that a
difficulty of breathing and chronic throat trouble were due to a
growth in the nose, corrected in a few minutes by operation.
A celebrated economist was forced to give up academic work, and
consecrated his life to painful and chronic dyspepsia because of eye
trouble detected upon the first physical examination. A woman secretary
suffered from alleged heart trouble; paralysis threatened, continuous
headache and blurred vision forced her to give up work and income; a
physical examination found the cause in nasal growths, whose removal
restored normal conditions. A woman lecturer on children's health heard
described last summer a friend's experience with receding gums: "'Why,
I never heard of that disease.' she said. 'Don't you know you have it
yourself'? I asked. She had never noticed that her gums were growing
away in little points on her front teeth. I touched the uncovered
portion and she winced. That ignorance has meant intense pain and ugly
fillings. If it had gone longer, it might have meant the loss of her
front teeth." A teacher lost a month from nervous prostration; physical
examination would have discovered the eye trouble that deranged the
stomach and produced the nerve-racking shingles which forced him to
take a month's vacation. A journalist lost weeks each year because of
strained ankles; since being told that he had flat foot, and that the
arch of his foot could be strengthened by braces and specially made
shoes, he has not lost a minute. A relief visitor, ardent advocate of
the fresh-air, pure-milk treatment for tuberculosis, had a "little
cough" and an occasional "cold sweat"; medical friends knew this, but
humored her aversion to examination; when too late, she submitted to an
examination and to the treatment which, if taken earlier, would most
certainly have cured her. A mother's sickness cost a wage-earning
daughter nearly $3000; softening of the brain was feared; after six
years of suffering and unnecessary expense, physical examination
disclosed an easily removable cause, and for two years she has
contributed to the family income instead of exhausting it. Untold
suffering is saved many a mother by knowledge of her special physical
need in advance of her baby's birth. Untold suffering might be saved
many a woman in business if she could be told in what respects she was
transgressing Nature's law.
[Illustration: NEW YORK CITY'S TUBERCULOSIS SANATORIUM AT
OTISVILLE IS SENDING HOME APOSTLES OF SEMI-ANNUAL EXAMINATIONS]
[Illustration: BOSTON'S PICTURESQUE DAY CAMP FOR TUBERCULOSIS
PATIENTS IS TEACHING THE NEED FOR A PERIODIC INVENTORY OF
PHYSICAL RESOURCES]
To encourage periodic physical examination is not to encourage morbid
thinking of disease. One reason for our tardiness in recognizing the
need for thorough physical examination is the doctor's tradition of
treating symptoms. After men and women are intelligent enough to demand
an inventory of their physical resources,--a balance sheet of their
physical assets and liabilities,--physicians will study the whole man
and not the fraction of a man in which they happen to be specializing
or about which the patient worries. By removing the mystery of bodily
ailments and by familiarizing ourselves with the essentials to healthy
living, we find protection against charlatans, quacks, faddists, and
experimenters. By taking a periodic inventory of our physical resources
we discharge a sacred obligation of citizenship.
FOOTNOTES:
[11] See _Dangerous Trades_, compiled by Thomas Oliver; also list of
reports by the United States Bureau of Labor.
CHAPTER XXII
HABITS OF HEALTH PROMOTE INDUSTRIAL EFFICIENCY
Education's highest aim is to train us to do the right thing at the
right moment without having to think. The technic of musician,
stenographer, artist, electrician, surgeon, orator, is gained only from
patient training of the body's reflex muscles to do brain work.[12] The
lower nerve centers are storehouses for the brain energy, just as
central power houses are used for storing electric energy to be spent
upon demand. From habit, not from mental effort, we turn to the right,
say "I beg pardon" when we step on another's foot, give our seats to
ladies or to elderly persons, use acceptable table manners. No person
seems "to the manner born" who has to think out each act necessary to
"company manners." How numerous are the mental and physical processes
essential to good manners no one ever recognizes but the very bashful
or the uncouth person trying to cultivate habits of unconsciousness in
polite society. The habit of living ethically enables us to go through
life without being tempted to steal or lie or do physical violence. No
person's morals can be relied upon who is tempted constantly to do
immoral acts; ethical training seeks to incapacitate us for committing
unethical deeds and to habituate us to ethical acts alone.
Eight different elements of industrial efficiency are concerned with
the individual's health habits,--the industrial worker, his industrial
product, his employer, his employer's profit, his trade or profession,
its product, his nation, national product. Obviously few men have so
little to do that they have time to think out in detail how this act or
that indulgence will affect each of these eight factors of industrial
efficiency. Once convinced, however, that all of these elements are
either helped or injured by the individual's method of living, each one
of us has a strong reason for imposing habits of health upon all
industries, upon employees and operatives, upon all who are a part of
industrial efficiency. When these eight relations are seen, parents and
teachers have particularly strong reasons for inculcating habits of
health in their children.
That industrial inefficiency results from chronic habits of unhealthy
living is generally recognized. The alcoholic furnishes the most vivid
illustration. The penalties suffered by him and his family are grave
enough, but because he has not full possession of his faculties he is
unpunctual, wastes material, disobeys instructions, endangers others'
lives, decreases the product of his trade and of his employer, lessens
the profits of both, depresses wages, increases insurance and business
risks. Because no one can foresee when the "drop too much" will be
taken, industry finds it important to know that the habit of drinking
alcoholics moderately has not been acquired by train dispatcher,
engineer, switchman, chauffeur. Because the habit of drinking
moderately is apt, among lower incomes, to go hand in hand with other
habits injurious to business and fatal to integrity, positions of trust
in industry seek men and women who have the habit of declining drink.
In the aggregate, milder forms of unhealthy living interfere with
industrial efficiency even more than alcoholism. Many capable men and
women, even those who have had thorough technical training, fail to win
promotion because their persons are not clean, their breath offensive,
their clothes suggestive of disorderly, uncleanly habits. Persons of
extraordinary capacity not infrequently achieve only mediocre results
because they fail to cultivate habits of cleanliness and health. An
employer can easily protect his business from loss due to alcoholism
among his own employees; but loss through employees' constipation,
headache, bad ventilation at home, irregular meals, improper diet, too
many night parties, nicotinism, personal uncleanliness, is loss much
harder to anticipate and avoid. Because evil results are less vivid, it
is also hard to convince a clerk that intemperance in eating, sleeping,
and playing will interfere with his earning capacity and his enjoyment
capacity quite as surely as intemperance in the use of alcohol and
nicotine. Where employees are paid by the piece, instead of by the
hour, day, or week, the employer partially protects himself against
uneven, sluggish, slipshod workmen; but, other things being equal, he
awards promotion to those who are most regular and who are most often
at their best, for he finds that the man who does not "slump" earns
best profits and deserves highest pay.
[Illustration: THESE PATIENTS ON THE OLD SOUTHFIELD ARE TAXING
THEIR UNIONS AND THEIR TRADES AS WELL AS THEIR FAMILIES AND THE
TUBERCULOSIS COMMITTEE]
There are exceptions, it is true, where both industrial promotion and
industrial efficiency are won by people who violate laws of
health,--but at what cost to their efficiency? Your efficiency should
be measured not by some other person's advancement, but by what you
yourself ought to accomplish; while the effect of abusing your physical
strength is shown not only in the shortening of your industrial life
and in the diminishing returns from your labor, but by the decrease of
national and trade efficiency. "Sweating" injures those who buy and
those in the same trade who are not "sweated" just as truly as it
injures the "sweated."
[Illustration: HABITS OF HEALTH AMONG DAIRYMEN MEAN SAFE MILK
FOR BABIES]
What are the health habits that should become instinctive and
effortless for every worker? What acts can we make our lower nerve
centers--our subconscious selves--do for us or remind us to do? The
following constitutes a daily routine that should be as involuntary as
the process of digestion:
1. Throw the bedding over the foot of the bed.
2. Close the window that has been open during the night.
3. Drink a glass of water.
4. Bathe the face, neck, crotch, chest, armpits (finishing if not
beginning with cold water), and particularly the eyes, ears, and
nose. If time and conveniences permit, bathe all over.
5. Cleanse the finger nails.
6. Cleanse the teeth, especially the places that are out of sight
and hard to reach.
7. Breakfast punctually at a regular hour. Eat lightly and only
what agrees with you. If you read a morning paper, be interested
in news items that have to do with personal and community
vitality.
8. Visit the toilet; if impracticable at home, have a regular time
at business.
9. Have several minutes in the open air, preferably walking.
10. Be punctual at work.
11. As your right by contract, insist upon a supply of fresh air
for your workroom with the same emphasis you use in demanding
sufficient heat in zero weather.
12. Eat punctually at noon intermission; enjoy your meal and its
after effects.
13. Breathe air out of doors a few minutes, preferably walking.
14. Resume business punctually.
15. Stop work regularly.
16. Take out-of-door exercise--indoor only when fresh air is
possible--that you enjoy and that agrees with you.
17. Be regular, temperate, and leisurely in eating the evening
meal; eat nothing that disagrees with you.
18. Spend the evening profitably and pleasantly and in ways
compatible with the foregoing habits.
19. Retire regularly at a fixed hour, making up for irregularity
by an earlier hour next night.
20, 21, 22. Repeat 4, 6, 8.
23. Turn underclothes wrong side out for ventilation.
24. Open windows.
25. Relax mind and body and go to sleep.
No man chronically neglects any one of the above rules without reducing
his industrial efficiency. No man chronically neglects all of them
without becoming, sooner or later, a health bankrupt.
In addition to this daily routine, there are certain other acts that
should become habitual:
1. Bathing less frequently than once a week is almost as dangerous
to health as it is to attractiveness.
2. Distaste for unclean linen or undergarments and for acts or
foods that interfere with vitality should become instinctive.
3. Excesses in eating or playing should be automatically corrected
the next day and the next. Parties we shall continue to have. It
will be some time before reasonable hours and reasonable
refreshments will prevail. Meanwhile it is probably better for an
individual to sacrifice somewhat his own vitality for the sake of
the union, the class, or the church. While trying to improve group
habits, one can acquire the habit of not eating three meals in
one, of eating less next day, of sleeping longer next night, of
being particularly careful to have plenty of outdoor air.
4. Visits to the dentist twice a year at least, and whenever a
cavity appears, even if only a week after the dentist has failed
to find one; whenever the gums begin to recede; and whenever
anything seems to be wrong with the teeth.
5. Periodic physical examination by a physician.
6. Examination by a competent physician whenever any disorder
cannot be satisfactorily explained by violation of the daily
routine or by interruption of business or domestic routine.
Health habits do not become instinctive until a continued, conscious
effort is made to accustom the body to them. When this is once done,
however, the body not only attends to its primary health needs
automatically, but it rebels at their omission, as surely as does the
stomach at the omission of dinner. Witness the discomfort of the
consumptive, trained to fresh air at a sanatorium, when he returns to
his overheated and underventilated home, or the actual pain experienced
in readjusting our own healthy bodies to the stuffy workroom or
schoolroom after a summer vacation out of doors. I heard a consumptive
say that he left a sanatorium for a day class after trying for three
nights to sleep in an unventilated ward. For many people the regular
morning bath is at first a trial, then a pleasure, and finally a need;
if omitted, the body feels thirsty and dissatisfied, the eyes sleepy,
and the spirit flags early in the day.
[Illustration: IMPROVISED SEASIDE HOSPITAL FOR NONPULMONARY
TUBERCULOSIS AT SEA BREEZE TEACHES PASSERS-BY THE FRESH-AIR
GOSPEL]
Cold baths are not essential or even good for everybody. The same diet
or the same amount of food or time for eating is not of equal value for
all. The temperature of bath water, the kind and quality of food, are
influenced by one's work and one's cook. Set rules about these things
do more harm than good. Such questions must be decided for each
individual,--by his experience or by the advice of a physician,--but
they must be decided and the decisions converted into health habits if
he would attain the highest efficiency of which he is capable. Here
again our old contrast between "doing things" and "getting things done"
applies. Get your body to attend to the essential needs for you, and
get it to remind you when you let the exigencies of life interfere.
Don't burden your mind every day with work that your body will do for
you if properly trained.
[Illustration: CRIPPLED CHILDREN LEAVING SEA BREEZE HOSPITAL FOR
BONE TUBERCULOSIS FIND STALE AIR OFFENSIVE BY NIGHT OR BY DAY]
Obstacles to habits of health are numerous; therefore the importance of
correcting those habits of factory, family, trade, city, or nation that
make health habits impracticable. We must change others' prejudices
before we can breathe clean air on street cars without riding outside.
When one's co-workers are afraid of fresh air, ventilation of shop,
store, and office is impossible. So long as parents fear night air,
children cannot follow advice to sleep with windows open. Unless the
family coöperates in making definite plans for the use of toilet and
bath for each member, constipation and bad circulation are sure to
result. Indigestion is inevitable if employees are not given lunch
periods and closing hours that permit of regular, unhurried meals.
Cleanliness of person costs more than it seems to be worth where cities
fail either to compel bath tubs in rented apartments or to erect public
baths. A temperate subsistence on adulterated, poisonous, or drugged
foods might be better for one's health than gormandizing on pure foods.
No recipe has ever been found for bringing up a healthy baby on
unclean, infected milk; for avoiding tuberculosis among people who are
compelled to work with careless consumptives in unclean air; or for
making a five-story leap as safe as a fire escape. Perfect habits of
health on the part of an individual will not protect him against
enervation or infection resulting from inefficient enforcement of
sanitary codes by city, county, state, and national authorities.
[Illustration: AT JUNIOR SEA BREEZE, TEACHING MOTHERS THE HEALTH
ROUTINE FOR BABIES]
The "municipalization" or "public subsidy" of health habits is
indispensable to protecting industrial efficiency. Public lavatories,
above or below ground, have done much to reduce inefficiency due to
alcoholism, constipation of the bowels, and congestion of the kidneys.
Theaters, churches, and assembly rooms could be built so as to drill
audiences in habits of health instead of fixing habits of uncleanly
breathing. Street flushing, drinking fountains, parks and breathing
spaces, playgrounds and outdoor gymnasiums, milk, food, and drug
inspection, tenement, factory, and shop supervision, enforcement of
anti-spitting penalties, restriction of hours of labor, prohibition of
child labor,--these inculcate community habits of health that promote
community efficiency. It is the duty of health boards to compel all
citizens under their jurisdiction to cultivate habits of health and to
punish all who persistently refuse to acquire these habits, so far as
the evils of neglect become apparent to health authorities. The
unlimited educational opportunity of health boards consists in their
privilege to point out repeatedly and cumulatively the industrial and
community benefits that result from habits of health, and the
industrial and community losses that result from habits of unhealthy
living.
FOOTNOTES:
[12] Serviceable guides to personal habits of health are _Aristocracy of
Health_ by Mary Foote Henderson, and _Efficient Life_ by Dr. Luther H.
Gulick.
CHAPTER XXIII
INDUSTRIAL HYGIENE
To call the movement for better factory conditions the "humanizing of
industry" implies that modern industry not influenced by that movement
is brutalized. The brutalizing of industry was due chiefly to a general
ignorance of health laws,--an ignorance that registers itself clearly
and promptly in factory and mine. It is not that a man is expected to
do too much, but that too little is expected of the human body. The
present recognition of the body's right to vitality is not because the
employer's heart is growing warmer, or because competition is less
vicious, but because the precepts of hygiene are found to be practical.
Where better ventilation used to mean more windows and repair bills, it
now means greater output. Where formerly a comfortable place in which
to eat lunch meant giving up a workroom and its profits, it now means
25 per cent more work done in all workrooms during the afternoon. The
general enlightenment as to industrial hygiene has been accelerated by
the awakening that always follows industrial catastrophes, by the
splendid crusade against tuberculosis, and by compulsory notification
and treatment of communicable diseases.
Catastrophes, however, have dominated the vocabulary that describes
factory "welfare work." Because accidents such as gas in mines, fire in
factories, fever in towns, and epidemics of diseases incident to
certain trades were beyond the power of the workers themselves to
control or prevent, wage earners have come to be looked upon as
helpless victims of the cupidity and inhumanity of their employers.
This attitude has weakened the usefulness of many bodies organized to
promote industrial hygiene. Although the term "industrial hygiene" is
broad enough to include all sanitary and hygienic conditions that
surround the worker while at work, it is restricted by some to the
efforts made by altruistic or farsighted employers in the interest of
employees; others think of prohibitions and mandates, in the name of
the state, that either prevent certain evils or compel certain
benefits; for too few it refers to what the wage earner does for
himself.
Pity for the employee has caused the motive power of the employee to be
wastefully allowed to atrophy. Yet when a man becomes an employee, he
does not forfeit any right of citizenship, nor does being an employee
relieve him from the duties of citizenship. In too many cases it has
been overlooked that a worker's carelessness about habits of health, as
well as about his machinery, causes accidents and increases industrial
diseases. Too often the worker himself is responsible for uncleanliness
and lack of ventilation and his own consequent lack of vitality. A
study into the conditions of ventilation and cleanliness of workers'
homes will prove this.
Knowing that a light, well-aired, clean, safe factory would not of
itself insure healthy men, many employers have built and supplied
houses for their workmen at low rents. Just as these employers failed
to see that they could reach more people and secure more permanent
results if they demanded that tenement laws and the sanitary code be
enforced as well as the laws for the instruction of children in
hygiene, so the employee has failed to see that he is a part of the
public that passes laws and determines the efficiency of factory
inspection. The enforcement of state legislation for working hours,
proper water and milk supply, proper teaching of children, proper
tenement conditions, efficient health administration, is dependent upon
the interest and activity of the public, of which the working class is
no small or uninfluential part.
[Illustration: COUNTRY CLUB HOUSE FOR NEW YORK SOCIAL WORKERS
Given by the founder of Caroline Rest Educational Fund]
The first and most important step in securing hygienic rights for
workingmen is to make sure that they know the rights that the law
already gives them. Men still throw out their chests when talking of
their rights. The posting of the game laws in a club last summer, and
the instruction of all the natives of the countryside in regard to
their rights as against those of outsiders, meant that for the first
time in their history the game laws were enforced. All the natives,
instead of poaching as has been their wont, joined together in
protecting club property from intruding outside sportsmen. Poachers
were caught and served with the full penalties of the law. Over winter
fires these people's heroism will grow, but their respect for law will
grow also, and it is doubtful if the game laws can be violated in that
section so long as the tradition of this summer's work lives. And so
it would be in a factory, if employees once realized that by uniting
they could, as citizens, enforce health rights in the factory.
The hygiene of the workshop is not the same problem as the hygiene of
the home and schoolhouse, because there are by-products of factory work
that contaminate the air, overheat the room, and complicate the
ordinary problems of ventilation. Certain trades are recognized as
"dangerous trades." The problem of adequate government control of
factories is one for a sanitary engineer. It has to do with
disease-bearing raw material that comes to a factory, disease-producing
processes of manufacture. There is need for revision of the
dangerous-trade list. Many of the industries not so classed should be;
many of the so-called dangerous trades can be made comparatively
harmless by devices for exhausting harmful by-products. Industrial
diseases should be made "notifiable," so that they can be controlled by
the factory or health department. It is those trades that are dangerous
because of remediable unsanitary and unhygienic conditions which demand
the employer's attention. Complaints should be made by individuals when
carelessness or danger becomes commonplace.
The manner in which many organizations have tried to better working
conditions is similar to the manner in which Europeans are trying to
help defective school children. Here, as there, is the difference
between _doing things_ and _getting things done_. Here more than there
is the tendency to exaggerate legislation and to neglect enforcement of
law. Instead of harnessing the whole army of workingmen to the crusade
and strengthening civic agencies such as factory, health, and tenement
departments, houses are built and given to men, clubs are formed to
amuse factory girls, amateur theatricals are organized. All this is
called "welfare work." "What is welfare work?" reads the pamphlet of a
large national association. "It is especial consideration on the part
of the employer for the welfare of his employees." In the words of this
pamphlet, the aim of this association "is to organize the best brains
of the nation in an educational movement toward the solution of some of
the great problems related to social and industrial progress." The
membership is drawn from "practical men of affairs, whose acknowledged
leadership in thought and business makes them typical representatives
of business elements that voluntarily work together for the general
good." As defined by this organization, welfare work is something given
to the employee by the employer for the welfare of both. It is not
something the employee himself does to improve his own working
conditions.
We are told that employees should assume the management of welfare
work.
Should they install sanitary conveniences? Of course not.
Would they know the need of a wash room in a factory if they never
had had one? No.
Should they manage lunch rooms? A few employers have attempted
unsuccessfully to turn over the management of the lunch rooms to
the employees, the result being that one self-sacrificing
subofficial in each concern would find the burden entirely on his
shoulders before working hours, during working hours, and after
working hours. Employees cannot attend committee meetings during
working hours, and they are unwilling to do so afterwards, for
they generally have outside engagements. Furthermore, the
employees know nothing about the restaurant business. If they did,
they would probably be engaged in it instead of in their different
trades. All experiments along this line of which we have heard
have failed. The so-called "democratic idea," purely a fad, never
has been successfully operated.
Many employers would introduce welfare work into their
establishments were it not for the time and trouble needed for its
organization. The employment of a welfare director removes this
obstacle. Successful prosecution of welfare work requires
concentration of responsibility. All of its branches must be under
the supervision of one person, or efforts in different directions
may conflict, or special and perhaps pressing needs may escape
attention. Pressure of daily business routine usually relegates
welfare work to the last consideration, but the average employer
is interested in his men and is willing to improve their condition
if only their needs are brought to his attention.
[Illustration: FIRST LESSONS IN INDUSTRIAL HYGIENE]
+--------------------------------------------------------------------+
| =Consumption= |
| |
| Is chiefly caused by the Filthy Habit of |
| |
| =SPITTING= |
| |
| TAKE THIS CARD HOME |
| |
| And show it to your family, friends, and neighbors |
| |
| Consumption is a disease of the lungs, which is taken from others, |
| and is not simply caused by colds, although a cold may make it |
| easier to take the disease. |
| |
| The matter coughed up and sneezed out by consumptives is full of |
| living germs or "tubercle bacilli" too small to be seen. These |
| germs are the cause of consumption, and when they are breathed |
| into the lungs they set up the disease. |
| |
| DON'T GET CONSUMPTION YOURSELF |
| |
| Keep as well as possible, for the healthier your body, the harder |
| for the germs of consumption to gain a foothold. Every person |
| should observe the following rules: |
| |
| |
| =DON'T= live, study, or sleep in rooms where there is no |
| fresh air. Fresh air and sunlight kill the consumption |
| germs and other germs causing other diseases; therefore |
| have as much of both in your room as possible. |
| |
| =DON'T= live in dusty air; keep rooms clean; get rid of dust |
| by cleaning with damp cloths and mops. =DON'T= sweep with |
| a dry broom. |
| |
| =KEEP= one window partly open in your bedroom at night, and |
| air the room two or three times a day. |
| |
| =DON'T= eat with soiled hands. Wash them first. |
| |
| =DON'T= put hands or pencils in the mouth, or any candy or |
| chewing gum other persons have used. |
| |
| =DON'T= keep soiled handkerchiefs in your pockets. |
| |
| =TAKE= a warm bath at least once a week. |
| |
| =DON'T= neglect a cold or a cough, but go to a doctor or |
| dispensary. |
+--------------------------------------------------------------------+
[Illustration: WELFARE WORK THAT COUNTS]
+-------------------------------------------------------------------+
| =HOW TO GET WELL IF YOU HAVE CONSUMPTION= |
| |
| If you or any one in your family have consumption, you must obey |
| the following rules if you wish to get well: |
| |
| =DON'T= waste your money on patent medicines or advertised |
| cures for consumption, but go to a doctor or dispensary |
| (see last page). If you go in time, you can be cured; if |
| you wait, it may be too late. |
| |
| =DON'T= drink whisky or other forms of liquor. |
| |
| =DON'T= sleep in the same bed with any one else, and, if |
| possible, not in the same room. |
| |
| =Good food, fresh air, and rest are the best cures. Keep out |
| in the fresh air and in the sunlight as much as possible.= |
| |
| =KEEP= your windows open winter and summer, day and night. |
| |
| =IF= properly wrapped up you will not catch cold. |
| |
| =GO= to a sanatorium while you can and before it is too |
| late. |
| |
| =The careful and clean consumptive is not dangerous to those |
| with whom he lives and works.= |
| |
| =Don't give consumption to others.= |
| |
| Many grown people and children have consumption without knowing |
| it, and can give it to others. Therefore every person, even if |
| healthy, should observe the following rules: |
| |
| =DON'T SPIT= on the sidewalks, playgrounds, or on the |
| floors or hallways of your home or school. It spreads |
| disease, and is dangerous, indecent, and unlawful. |
| |
| =WHEN YOU MUST SPIT=, spit in the gutters or into a spittoon |
| half filled with water. |
| |
| =DON'T COUGH OR SNEEZE= without holding a handkerchief or |
| your hand over your mouth or nose. |
+-------------------------------------------------------------------+
$/
This method of promoting the welfare of the worker may have been a
necessary step in the development of industrial hygiene. Undoubtedly it
has succeeded, in many cases, in bringing to an employer's
consciousness the needs of his workmen, in accustoming employees to
higher sanitary standards, and in teaching them to demand health rights
from their employers. In many cases, however, "welfare work" has
miseducated both employer and employee. The fact that "the so-called
democratic idea, purely a fad, has never been successfully operated,"
is due to the interpretation given to "democratic idea." The two
alternatives in the paragraph above quoted are lunch rooms, wash rooms,
as gifts from employers to employees, or lunch rooms and wash rooms to
be furnished by employees at their own expense. The true democratic
idea, however, is that factory conditions detrimental to health shall
be prohibited by factory legislation, and this legislation enforced by
efficient factory inspectors, regardless of what may be given to
employees above the requirement of hygiene.
Until employees are more active as citizens and more sensitive to
hygienic rights, it is desirable that welfare directors be employed in
factories to arbitrate between employer and employee, to raise the
moral standard of a factory settlement, to organize amusements.