Earthen pipe drains become broken or their joints leak, and they
saturate the ground under a house with sewage. (2) Tree roots break
and clog drain pipes. (3) The pipes sometimes have not fall enough.
(4) Drains without running traps admit sewer gas. (5) Rats burrow
along a drain pipe from the sewer into the house and admit sewer gas.
(6) When the soil pipe from a water-closet is exposed in cold weather
it may freeze up or be clogged by urinary deposits. (7) Rats gnaw
through lead pipes and joints. (8) Two or more closets or sinks with
unventilated {204} traps on the same pipe will siphon back sewage. (9)
Overflow pipes sometimes have no traps and they let in gas. (10) Ash
pits near a house carry moisture to walls, (11) Cesspools leak through
the soil.
In planning a school-building the classrooms and the study-halls are
the first things to be considered. The classrooms should be oblong,
with the aisles running lengthwise. Each child should have at the
least 15 square feet of floor space and 200 cubic feet of air space. A
room 30 by 25 feet with a ceiling 13 feet from the floor will serve
for 48 pupils and no more. This is the best size for a room when
blackboards and maps are used in teaching, because a larger room sets
the children in the back seats too far away to see without eye-strain.
Dormitories should have at the least 300 cubic feet of air space for
each child, and great care is to be taken in the ventilation. Children
about 10 years of age require 11 hours of sleep; under 13 years,
10-1/2 hours; under 15 years, 10 hours; under 17 years, 9-1/2 hours;
under 19 years, 9 hours. Do not make children get out of bed before
seven o'clock in the morning; do not let them study before breakfast,
and do not force them to work after half-past eight or nine o'clock at
night until they are at the least 17 years of age. The hours for work
should be:
Ages Hours of work a week
From
5 to 6 6
6 to 7 9
7 to 8 12
8 to 10 15
10 to 12 20
12 to 14 25
14 to 15 30
15 to 16 35
16 to 17 40
17 to 18 45
18 to 19 50
Work given for punishment must be included in these hours. No one,
even an adult, should study for more than two hours at a time without
an intermission for a few {205} minutes. In a boarding-school no one
under any pretext, even on rainy days, should be permitted to study
during recreation hours, and the deprivation of recreation to make up
lessons is a relic of barbarism. If a teacher can not get class work
done except by shutting up children during recreation hours, remove
the teacher or expel the pupil.
The amount of glazed window surface admitting light to a classroom or
study-hall should be from one-sixth to one-fourth the floor space of
the room, and this must be increased if the light is obstructed by
neighbouring houses or trees. The light is to be admitted on the left
side of the pupils,--all other windows should be counted as
ventilators only. Windows facing the children or the teacher are to be
avoided. In rooms fourteen feet high a desk twenty-four feet from a
window is insufficiently lighted. The larger the panes of glass the
better, and the external appearance of windows is to be sacrificed to
good lighting. If screens are used to protect the glass from
stone-throwing, allowance is to be made for the light the screens cut
off.
If a room can not have enough light from the left side alone, put the
additional windows on the right so that their lower sills will be
eight feet from the floor; and be careful in this case that the light
from the right is not brighter than that from the left.
Windows should have as little space as possible between them to avoid
alternate bands of shadow and light. Set them up as near the ceiling
as possible, since the higher they are the better the illumination;
and they should not be arched at the top. The lower window sills may
be about four feet from the floor. When window shades are used to cut
off direct sunlight, they should be somewhat darker in colour than the
walls.
If artificial light is used in boarding-schools in the study-halls,
the best light is one that is as near in colour as possible to the
white light of the sun, and ample, but not glaring. It should be
steady, and it should not give out great heat nor injurious products
of combustion. Hence the electric light is the best; after that, gas
through Welsbach {206} or Siemens burners. Well refined kerosene oil
gives a good light, but it is always dangerous. Acetylene gas is now
used in a safe apparatus, and it also is an excellent light.
No colour that absorbs light should be used on the walls. Pale
greenish gray, nearly white, is the most satisfactory colour. There
should be no wall paper, curtains, or hangings of any kind in a school
or college building. The wall decorations should be as plain as
possible, with no roughened places to catch dust.
Stairways are to be well lighted; they should be at the least five
feet wide, and have landings half-way between each story. Diagonal or
spiral stairways are dangerous. Steps with six-inch risers and
eleven-inch treads are the easiest for children, but
six-and-a-half-inch risers may be used in high schools and colleges.
Carbonic acid in the air of a classroom is an index of impurity.
External air has about three parts of carbonic acid in 10,000 parts of
air, and above seven parts in 10,000 is injurious. Each person exhales
about fourteen cubic feet of carbonic acid gas in an hour. There is no
easy method of determining the quantity of carbonic acid gas present
in a room, and we must therefore arrange the ventilation so that about
3000 cubic feet of fresh air an hour will be supplied to each person
in the house.
Beside carbonic acid there are other impurities in house air, as dust,
micro-organisms of disease, exhalations from bodies, sewer gas, and
the like, which accumulate and do injury when the ventilation is
defective.
If every person in a house has 1000 cubic feet of air space, natural
ventilation will suffice ordinarily, but artificial ventilation is
needed in schoolrooms and dormitories. The subject of ventilation can
not be satisfactorily discussed in a short article, and those that are
interested in school building should leave the matter to a competent
architect, or study books and articles like J. S. Billings'
_Ventilation and Heating_, Pettenkofer's _Ueber Luft in den Schulen_,
and Kober's article on House Sanitation in the _Reference Handbook of
the Medical Sciences_.
{207}
The proper heating of a schoolroom is a matter so generally understood
that there is no need for special remark here, except this, that
provision for proper humidity in the heated air is commonly neglected.
Cheap water-closets do not save money--they get out of order too
easily. The pan, valve, and plunger hoppers are not to be tolerated.
The only kind to use are short-hopper closets with a trap that opens
into the soil-pipe above the floor. These may have valve-lifters
attached to the seats, because children forget to flush the hoppers.
The ventilation of the water-closets should be separate from that of
the main building. In country places where vaults are used, there
should be a supply of dry loam kept, and enough of this to cover the
fresh contents should be thrown into the vaults every evening.
Children are seemingly always thirsty, and they should be allowed to
have all the drinking water they want if the source is free from
typhoid germs and infection by organic matter. Common cups are an
abomination, and a prolific cause of contagious diseases. Each child
should have its own cup.
The rules for desks and seats for children are these:
1. The height of the seat should be about two-sevenths of that of the
body.
2. The width of the seat should be about one-fifth of the length of
the body, or three-fourths the length of the thigh. Do not keep
unfortunate little children's feet dangling all through their school
years to save a few pennies on school furniture.
3. The seat should slope downward a little toward the back, be
slightly concave, and have rounded edges in front.
4. There must be a back-rest.
5. The child, when sitting erect, should be able to place both
forearms on the desk without raising or lowering the shoulders. This
is a very important rule.
6. The seat must be correctly placed as regards the distance of its
front edge from the corresponding edge of the desk.
7. The desk slope should be 15 degrees.
{208}
Badly constructed desks cause eye-strain and marked distortions of the
spine. Desks should be adjustable in height, especially for growing
children. School-children grow most rapidly between the ages of twelve
and sixteen years--nearly two inches a year--and the desks and seats
should be adjusted twice a year at the least. If a child is moved to
another desk an adjustment is to be made at once.
To counteract the bad effect of long sitting, even at properly
adjusted desks, children should be frequently sent to blackboards, and
at regular intervals a few minutes are to be given to "setting up"
exercises.
Great attention should be paid to the eyesight of children. Those that
complain of headache should have their eyes examined. The lines in
school books should be not more than four inches in length, and they
are to be printed in clear, well-leaded type. Slates are dirty and
unsanitary: let the children write on paper that has a dull finish.
Teachers should prevent lounging positions at desks, especially
stooping. They are not, however, to try to make children under fifteen
years of age sit still. The youngsters can not remain immovable, and
the effort to make them do so is irritating to no purpose.
Nervous children need outdoor exercise more than anything else. When
nervousness takes the form of religious scrupulosity in
school-children and novices do not immediately apply a moral theology
to them--call in a physician that has common-sense, because there is a
nervous scrupulosity which is much more frequently met with than the
purely spiritual form. Aridity in prayer, a loss of sensible devotion,
and similar troubles have to do with advance in the spiritual life,
but they more commonly have to do with the liver in persons that are
not nearly so important spiritually as they fancy they are; and in
these cases the cook is the particular devil at fault, if they have
exercise enough.
One of the chief sanitary evils in our boarding-schools, convents, and
similar institutions, is the stupid sameness in the food which may be
otherwise unobjectionable. The meat, for example, may be good, but the
college and seminary cook sends it into the refectory chilled and
clammy, or hot and overdone. In any case it is everlastingly the {209}
same. Children can predict a dinner's ingredients a month in advance.
Give children meat twice a day; white flour in their bread, because it
is digested better than whole flour; all the sugar they want at meals;
milk rather than tea, and tea rather than coffee; but let it be tea,
not a dose of tannic acid.
The physical education of girls is neglected. Their general education
is effeminate rather than feminine. If a convent faculty grows bold
and "modern" it hires a teacher of gymnastics, puts an "extra" on the
bill of expense, and ten or twelve wealthy girls play at gymnastics if
they are not too lazy. Even if the whole school is obliged to attend
the club-swinging and posturing and the other nonsense, little good is
done. Girls should be kept out of doors for their exercise, and fresh
air is much cheaper than a gymnastic teacher. If school-girls were
forced into the open air more, they would not have time for munching
caramels over the erotic spasms of Araminta and Reginald in the
popular novel, and there would be advantage in the change. The absence
of daily, regular, and sufficient exercise renders girls listless,
anaemic, sallow, foul-breathed, melancholy, stooped, irritable.
Do not permit boys under eighteen years of age to go into regular
training for college track-teams. Their hearts are not strong enough
for the strain.
Boys should not use tobacco in any form, but it is useless to try to
make them believe this statement. Tobacco stunts a boy, causes
dyspepsia, and renders his mind dull. The measurements made for years
at Yale, Amherst, and other colleges, by physical directors, show
remarkable reduction in the height and chest expansion in tobacco
users as compared with boys that do not smoke. Cigarette smoking would
not be different from other smoking if it did not so readily tend to
excess. Cigarette smoke is inhaled more than the smoke from cigars and
pipes, and thus more of the injurious ingredients of tobacco are
absorbed.
{210}
If a boy will smoke let him use a good long-cut tobacco which has
little or no Perique tobacco in it, in a "Remington," "Edison," or
similar wooden pipe. These are pipes with stems of large calibre, and
in the stem there is a roll of absorbent paper or pith which keeps the
pipe clean. Cigars, no matter how costly they may be, are too strong
for a boy and for most men. A poor cigar irritates the throat aside
from the regular effect of the tobacco, especially if there is much
nitre in the wrapper. Meerschaum pipes are dirty and too strong. The
tongue is irritated by a pipe that has a small bore in the mouthpiece:
use a mouthpiece that has as large a bore as possible. Cigar smokers
should, after cutting off the end of a cigar, blow the dust out of it
from the lighting end to avoid inhaling this irritating dust.
AUSTIN OMALLEY.
{211}
XVII
MENTAL DISEASES AND SPIRITUAL DIRECTION
It is a well-recognised fact that persons suffering from many forms of
beginning mental disease are likely to be affected by an exaggeration
of religious sentiment. An unaccountable increase in piety is
sometimes the first warning of approaching mental deterioration. It is
not hard to understand why this should be, since religious feelings
occupy so prominent a place in the minds of the majority of people,
and the removal of proper control over mental operations of all kinds
leads to an exaggeration, especially of those that have meant most for
the individual before. Supposed religious vocations, especially when
of sudden development, are sometimes no more than an index of
disturbed mentality. Every confessor of lengthy experience has had
some examples of this. This makes it important that clergymen should
have a knowledge of at least the first principles on which the
diagnosis of mental diseases is made. Superiors of religious
communities, and especially those that have to decide as to the
suitability of those applying for entrance to, or already in probation
for, the religious life, need even more than others a definite
knowledge of the beginning symptoms of the various mental diseases,
and of the types of individuals that are most prone to suffer from
them.
Besides, confessors and religious friends and advisers often gain the
confidence of the mentally diseased much more fully than any one else.
It is to them especially that the earliest symptoms of beginning
mental disturbance are liable to be first manifested. After all, a
pastor's and a {212} confessor's duty is bound up with the welfare of
his spiritual children in every sense; and it would be supremely
serviceable to the patients themselves and to their friends, if these
earliest symptoms could be recognised and properly appreciated, and
due warning thus given of the approach of further mental
deterioration.
The mental diseases that are of special interest in this respect are
the so-called idiopathic insanities. Idiopathic is a word we medical
men use to conceal our ignorance of the cause of disease. Idiopathic
diseases are those that have come of themselves, that is, without
ascertainable cause. As a matter of fact, the most important group of
mental diseases develop without presenting any alteration of the brain
substance, so far as can be detected by our present-day methods of
examination. The initial symptoms of these diseases, then, are of
great importance, and not readily recognisable unless looked for
especially. There is no physical change to attract attention, and the
change of disposition and mental condition is often insidious and only
to be recognised by some one who is in the confidence of the patient.
It is in these idiopathic insanities, then, that the careful
observation of the clergyman is of special significance. Needless to
say, powers of observation to be of service must be trained.
While there are no known changes in the brain tissues in these
diseases, it seems not improbable that the development of our
knowledge of brain anatomy, which is especially active at the present
time, will very soon demonstrate the minute lesions that are the basis
of these mental disturbances. It seems not unlikely that the
underlying cause of so-called idiopathic insanity is usually some
change within the brain cells. Hints of the truth of this conjecture
are already at hand. Meantime the actual observation of this class of
patients in asylums and institutions, private and public, and the
collation of the observations of authorities in psychiatry from all
over the world, have thrown a great deal of light on these forms of
mental disease. We know much more of the initial symptoms and of
incipient conditions that threaten the development of mental {213}
disequilibration than we did twenty-five years ago. With regard to
prognosis especially, recent publications have added considerably to
our knowledge, although it must be confessed that they have rendered
our judgment of such cases much less hopeful.
The ordinary forms of mental diseases have sometimes been considered
as passing incidents in the lives of patients suffering from such
disorders. While it was generally understood that severe cases were
apt to have recurrences, and that after persistence of mental symptoms
for a certain length of time the outlook as regards eventual absolute
cure is rather dubious, yet the general prognosis of such simple
states as melancholia or simple mania was not considered to be
distinctly unfavourable. Patients might very well recover their mental
sensibility after even a severe attack, and never have a relapse.
It was something of an unpleasant surprise to the medical world, a few
years ago, when one of the most distinguished authorities in Europe on
the subject of mental diseases, Professor Kraepelin, of the University
of Heidelberg, stated in his text-book of psychiatry, that among a
thousand cases of acute mania he has observed only one in which the
symptoms did not recur. Professor Berkley, of Johns Hopkins
University, Baltimore, a conservative American authority, in
discussing this subject of relapses after single occurrences of mania,
is evidently of the opinion that Professor Kraepelin's opinion in the
matter presents the inevitable conclusion that must be drawn from
recent advances in the clinical knowledge of maniacal conditions.
"Simple mania," he says, "is, according to the statistics now at hand,
an exceedingly rare form of mental disease, and the physician should
therefore be cautious in making a prognosis of final recovery.
Relapses after a number of years, when stability is apparently
assured, are frequent, as every one interested in mental medicine
knows only too well."
The more experience the specialist in mental diseases has, the less
liable he is to give an opinion that will assure friends of the
patient that relapses may not occur after any form of disturbed
mentality. While this is true in mania, {214} it is almost more
generally admitted with regard to melancholia. Most patients who have
one attack of severe depression of spirits will surely have others if
they are placed in circumstances that encourage the development of
melancholic ideas. Any severe emotional strain will be followed by at
least some symptoms of greater depression than would be expected from
the normal person under the same conditions.
Professor Kraepelin has pointed out that in about one out of six cases
the patients who came to him supposedly for the treatment of primary
attacks of melancholia proved to be really suffering from a relapse of
severe mental depression. The careful investigation of the history of
these cases showed that they had suffered from previous attacks of
depression, though sometimes these were so slight as not to have
attracted any special attention from the medical attendant,--if
indeed one had been called in the case--and at times even failed to
occasion more than a passing remark on the part of friends with whom
the patient was living.
The most frequent form of idiopathic insanity is melancholia. The
disease is characterised by depression of spirits. Professor Berkley's
definition, besides being scientifically exact, is popularly
intelligible. According to him, "Melancholia is a simple, affective
insanity in persons not necessarily burdened by neuropathic heredity,
characterised by mental pain which is excessive, out of all adequate
proportion to its cause, and accompanied by a more or less
well-defined inhibition of the mental faculties." This latter part of
the definition is extremely important. In extreme cases patients are
able to accomplish no other mental acts beyond those which concern the
supposed cause of their depression. Their lack of attention to other
things is the measure of the mental disturbance. Their minds
constantly revolve about one source of discouragement. They become
absolutely introspective and their surroundings fail utterly, in
pronounced cases, to produce any reaction in them. In milder cases
this involves an increasing neglect of whatever occupation the patient
may have, solely for the purpose of giving up time to the
contemplation of the cause of his depression.
It is not easy always to recognise the limits between a {215}
depression of spirits that is not entirely abnormal and a
corresponding state of mind that is manifestly due to insanity. When
misfortunes occur, individuals will be mentally depressed. Sorrow has
in it necessarily no element of mental alienation. It is only when it
becomes excessive that observers realise that there is disturbance of
the mental faculties, causing the undue persistence and the
exaggeration of the grief.
For example, a mother loses an only son in the prime of manhood and at
the height of his career. It will not be surprising if, for a
considerable period, she is unable to take up once more the thread of
life where it was so rudely interrupted. For weeks she may react very
little to her surroundings and may prove to be so moody as to arouse
suspicion of her mental condition. After a time, however, she begins
to have some of her old interest in affairs around her. Her depression
of spirits may not entirely disappear for long years, perhaps never;
but her affective state does not go beyond a simple sorrow. On the
other hand, under the same circumstances, a mother may give way to
transports of grief that after a while settle down into a persistent
state of dejection. Every thought, every word, every motive, has a
sorrowful aspect to her. After a time she may begin to think and even
to state that the misfortune of the loss of her son has come because
of her own exceeding wickedness. She may consider it a punishment from
on high and think that she has committed the unpardonable sin and
absolutely refuse any consolation in the matter. This state of mind is
distinctly abnormal, and if it persists for some time must lead to the
patient's being kept under careful surveillance.