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matter that we cannot discuss here, although it is evident that the best work cannot be obtained from the underfed.
When we consider the lack of facilities of obtaining fresh air by our school children, we find one of the most potent elements in the production of disease among them. The defective ventilation of school buildings is in common with all public buildings, and the popular fear of a draught often interferes with a sufficient opening of windows.
In the consideration of outdoor play, it is necessary to separate the private school children from the public school children, and we must also remember that it is not sufficient to give all children an opportunity to get into fresh air if they will, but that it is necessary to force some children of natural sedentary habits to play out of doors.
Children go to school in the morning, remaining until noon; return at one, remain ing until perhaps three, after which some will play in the streets and others return to their homes, having had practically no out-of-door play during the day.
New York has previously offered few facilities for outdoor play for school children. It seems to me that the provision for this outdoor play, which is essential to their health, and thus must be obtained if they are to do good school work, should devolve upon the educational authorities.
This problem may be solved to some extent by the public school, which could keep the children under supervision during the whole day, having a supervisor of physical exercise remain with them before and after school hours, when they could play in enclosed cages on the roofs or in adjacent public parks under supervision.
The important influence that such supervision would have, not only upon the physical condition but on their moral development, would be worth to the city far more than the expense for the suppression of crime when these children grow up.
In some of our best private schools provision for play under supervision is made, but such play is too often carried on in closed rooms, and not out of doors, so that a large part of the advantage that might accrue from it is thus lost. My own feeling is that the time will soon come when our best private schools will move to the suburbs of the city, where, instead of occupying a plot fifty by one hundred, they can have several acres of land. The child could sleep at home, go to the school in the morning, obtain the outdoor play there, and return to his home late in the afternoon. The parents would thus remain in touch with their children in a way not possible at boarding schools, while at the
same time the children would enjoy the facilities for outdoor play which are such an advantage to our boarding school children.
The effort to protect school children from disease has brought about many improvements in our public school system, but has not as yet effected many changes in private schools, although some inspection exists in many of the latter. The excluding of sick children has never been as rigidly carried out as it should be to protect those that are well. So far as I know children with colds are excluded from only one private school in New York City, while it is well known that so-called colds are often an evidence of influenza, which is a very contagious disease; that they exist for three days preceding the eruption of measles, while what is known as a cold is the common phenomenon of the first two weeks of whooping-cough before the characteristic cough develops. If children with colds were absolutely excluded from our schools measles epidemics would not travel so fast, whooping-cough would be much less prevalent, and through the diminution of influenza school attendance would be markedly improved.
I was recently called to see a boy suffering from sore throat, who was attending a kindergarten class of eight children. I asked him whether the children had all been in attendance on the preceding day. He said no, that he was the only child there. I visited the school the following day and found no member of the class present, and on inquiry learned that one of the children had come to school with a slight cold the week before. Had that child been excluded it is not likely that the other seven children would have been absent at that time.
Next to colds, the most common evidence of contagious diseases in children may be said to be eruptions; so that no child with an eruption should be allowed at school until the eruption has been pronounced by a competent person is not an indication of a contagious disease. The presence of dust in school rooms as naturally a source of danger, and should be reduced to a minimum by careful and proper cleaning of the floors and furniture.
Fatigue in school children was well demonstrated in a scientific manner by Dr. Christopher of Chicago, who supervised some excellent work on the public school children of that city. that city. By means of the ergograph, which tests motor activity in the middle finger, he examined a number of children in different schools. In each case he found their activity greatest when entering school at nine o'clock; that it diminished rapidly during the morning session, reaching its lowest point at noon,
when they were dismissed.
At one, after returning, it had reached about the same maximum as at nine in the morning, and during the afternoon diminished even faster than during the morning. He found the same results in all the children tested, except in one group of four boys in one of the schools, who showed no deterioration in physical activity during the day. On investigating these cases it was found that the teacher of these boys had been absent, and while they had been in school all day they explained that they had been having a good time. It, therefore, appeared that this deterioration in physical activity, when present, was the result of prolonged application, and not of the confinement in school.
The relief of school children from worry and from fatigue from prolonged application can best be secured by shortened school hours, by short periods devoted to any one subject, and frequent recesses devoted to physical exercise. Such a scheme should be so worked out that, when controlled by some instrument such as that used by Dr. Christopher, school work would result in no appreciable deterioration
Through the kindness cf Miss Carse, the principal of the Charlton school, I have tested for fatigue certain children under her care. I choose for the test children who were for. the first time undertaking work that required concentration-that is, children of about seven
I applied the Crampton test for fatigue, the comparison of pulse rapidity and blood pressure, taken standing and lying down, and the test with the ergograph.* The children were tested just after coming to school at nine o'clock and just before leaving at half-past twelve. In none of the children examined was any marked fatigue shown. Most of the tests average as good at twelvethirty as at nine o'clock in the morning. The reason for this striking absence of fatigue may be found in the examination of the daily program. The school day lasts only from nine to twelve-thirty. The session consists of periods of but fifteen minutes devoted to any subject, and each fifteen minutes the children are alternately standing and sitting. The middle of the session is interrupted by a fifteen-minute recess out of doors, and an hour later by a five-minute recess spent in jumping through the seats. These observations of mine are too limited to base large conclusions upon, but the unusual absence of fatigue in most of the children examined would seem to indicate that the program was very successful.
The writer is indebted to Professor E. S. Lee of the College of Physicians and Surgeons, Columbia University, for many valnable suggestions and for the apparatus loaned to him for the experiments.
There can be no question but that proper physical development is more important for our school children than any knowledge that can be imparted to them. The acquirment of knowledge accomplished by physical injury is harmful, not beneficial.
It is usually the case that when little children of five years, who have previously been kept out of doors all day, and have had no concentration on any subject, enter kindergarten classes, where a session of one hour should be sufficient, you will find two and one-half hours required, during which period not more than twenty-five minutes of recess is allowed. As they grow older, at ten years four hours will be required, with no more recess than the kindergarten child had, and with more time devoted to the preparation of lessons of the following day.
It is my opinion that for children between five and ten years of age not more than ten or or fifteen minutes should be devoted to any one subject, and that this period should be followed by five minutes of active exercise in the open air or with the windows open; that but one hour should be devoted to work by one-half hour should be added each succeedchildren of five years, and that not more than ing year up to ten years; and that a part of school day should be out-of-door play in the afternoon under supervision.
To summarize, then, our ideal private school should be out of town, but within easy reach of the homes of its patrons. It should have short periods of study, separated by frequent recesses, and ample time allowed for a substantial midday meal, taken at leisure. The harder work should be given during the morning hours, the lighter work in the afternoon hours, to be followed by play out of doors, in which all the children must take part.
The ideal public school should take the children as many hours a day as practicable. They should come to school as early as eight in the morning and enjoy an hour's outdoor play under supervision before undertaking their tasks. The periods devoted to each subject should be short, with frequent recesses. At noon a nutritious but simple meal should be furnished them. In the afternoon the easier subjects, the manual work, and the preparation for the lessons of the next day should be taken up. Opportunity for outof-door exercise under supervision until late in the afternoon should be provided.
In both private and public schools a much more severe examination for any evidence of contagious diseases should be made than at present. All children with colds should be absolutely excluded from school, and child
ren with eruptions should be excluded until the eruption has been pronounced by a competent person noncontagious in character.New York Medical Record.
THE king of the Belgians, as sovereign of the Congo Free State, is offering a prize of 200,000 francs, open to all nationalities, for the discovery of a method of successfully treating sleeping sickness.
KING EDWARD thinks the spread of sleeping sickness in Africa is one of international importance and has asked the Liverpool School of Tropical Medicine to submit a plan for the prevention of the disease. He promised his co-operation if it is in any way possible or practicable.
AT the meeting of the Association of Military Surgeons, held in Buffalo recently, it was announced that the Enno Sanders prize had been awarded to Major Pilcher for an essay on "The Training of the Medical Officer of the State Forces to Best Qualify Him for Local Service and for Mobilization with National Troops."
EPILEPSY.-Two remedies have recently been introduced for the treatment of epilepsy. One of these is verbenin, which has been highly recommended by a number of clinicians; especially in cases of gastrointestinal irritation from worms or other causes. The other is solomine, the alkaloid of the horse nettle. The plant has attracted a great deal of attention as remedy for the nervous irritability which render the epileptic more liable than ordinary persons to suffer from these explosions. The Journal of Advanced Therapeutics.
DENATURIZED ALCOHOL will become a fact in this country on January 1, 1907. The rules and regulations have been published at great length by the Department of Internal Revenue. These provisions are being criticized by those familiar with the denaturizing of alcohol in Europe. It is, however, best to wait for a few months of practical tests before expressing an opinion on the feasibility of the government regulations. One point is, however, evident and that is the desire of the department to provide for the use of denaturized alcohol in the various arts and industries. The small distiller seems to have been left out of consideration so that farmers will not become distillers but profit by an increased demand for their alcohol making products. Every precaution, as might be expected, will be taken to prevent defrauding the government out of internal
LOCAL conditions seem to have designed these as days of reform in many walks and
Honor for a Car Ticket.
we, in the medical profession, are not finding our lives free from need of greater or lesser improvements. It is a littions as to needed medical reforms there has tle surprising that among the many suggesbeen such a speaking silence in the matter of contract practice; in many sections this has been heralded as the foremost foe of legitimate and honest medicine; societies have issued their pronouncement against it and have banded their individual membership in a pledge that it shall be effaced. Nothing of the kind has happened in St. Louis; we have struggled for the elimination of the "50-centa-month hospital" and against examining for life insurance for less than $5.00, and for many lesser reforms, are we to conclude that contract practice does not exist here? The suggestion seems something of a joke, for we all know that there is hardly a corporation doing business in our city which has not its physician, or its medical staff, and which is not getting medical service at rates which would surprise the average householder. We know of no legitimate reason why a physician should serve a corporation for less fee per case than he will allow the wage earner who sweats for every cent he gets, and pays his physician with a warning to his family that they must exercise economies, because he has done so. Economies! And that in the face of such economy as few of us know anything of. But the fattening corporation which deals in first dressings and plans for protection from subsequent damage suits, can buy physicians body and soul for a paltry $300 or $500 per year, and receive from him
in return, not only scientific service for which regular rates would net the doctor many times as much, but such protection in case of subsequent actions for legal redress as could not be bought in an honest market.
Patients from such a practice net the doctor very little per capita, but they are great as chair warmers, and to show that things are doing in the doctor's line, his is a busy office! To us such practice seems one of the worst prostitutions of medical honor that has been devised. The medical man's first interest should be in the patient and remedying his ailment, to consider the employing corporation and have thought of protecting it financially in connection with work on the case is much more reprehensible than is doing the work for a less fee than would be charged the patient were he to pay the bill himself. It is the patient every time who should have every consideration, concession and protection which it may be in our power to give, and he who sells these to an outside party is unworthy of the medical mantle.
It comes to our ears that there is an. other class of physicians in St. Louis which, while nct openly employed by corporations, is tacitly pledged to their protection in return for favors received, we refer to those who ride on car tickets, and who are expected to interest themselves in case of emergency accidents in their neighborhood, and that to the advantage of the company. This would seem almost beyond belief, but the report comes with such persistence that there must be truth in it. How a man who holds a medical degree and poses as meriting the dignity which should be characteristic of every physician could allow himself to be party to such an arrangement is beyond comprehension.
Honor for a car-ticket!! To
what are we coming?
It is not the newly graduated and struggling physician who is in on these reprehensible practices. The contract physician is in the amen corner, and his voice is heard in call for reforms. To hint at unrighteousness when speaking of his character is like questioning the virtue of the gods, and is rarely tolerated and never given serious consideration.
These days of reforms and medical reforms are quite as much needed in high places as elsewhere; it is time to make the profession of St. Louis, of NEW St. Louis, above reproach, and lets make a clean job of it.
SUBSCRIBE for The Medical Fortuightly.
Errors in Medical English.
A RECENT issue of the Journal of the American Medical Association contains a communication from Dr. W. W. Keen, calling attention to some of the more common and distressing errors in medical English. The letter is one which merits wide republication, as every writer on medical subjects should be certain that his copy is free from the errors, and he should also have his attention drawn to the fact that his readers are critical and find it difficult to excuse bad English. Dr. Keen says: "May I call attention to two very common instances of faulty English which I am constantly meeting in letters, in print, and in conversation? One is the assertion that 'the patient had no temperature.' I presume that the writer does not mean that the patient's temperature was zero, but that he had no rise of temperature beyond the normal. Certainly a temperature of 98.4 F. is universal in the well. Any rise above that should never be called 'temperature,' but a 'rise of temperature,' or 'an increase of temperature. temperature falls below 98.4, to 97 or 96 F., how would those who speak of any rise above 98.4 F. as 'temperature' designate such a fall-less than no temperature?"
"The other instance is really an atrocious misuse of the language. I constantly hear it used orally. In a rceent letter occurred the phrase, since my case, I have seen two others operated;' and in a single number of an admirable, well-known medical journal occurs the phrases 'the first case to be diagnosed or operated in P,' 'three further cases have been observed and operated here,' and two other similar transgressions.
"May I call attention also to a confusion. of two similar terms? "Tubercular' and 'tuberculosis' are constantly used interchangeably. At the last tuberculosis congress in Washington I proposed to the executive committee that we should recognize definitely in all our publications a distinction between the words as follows: Tuberculous shall be used only of those lesions caused by the tubercle bacillus. Tubercular shall be used in describing those lesions which resemble tubercles, but which are not caused by the tubercle bacillus, for instance, tubercular syphilid, etc. This suggestion was adopted and the proposed usage approved."
ONE reason why some people are still the happy possessors of an appendix is that they didn't have the price of the operation, and were never picked up unconscious on the streets.-The Trio.
The Hospitals of New St. Louis
We present this issue excellent pictures of two of the Bethesda institutions, the Hospital and Home for Incurables