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Book_L£j^_|T 
 
DR. D. HARVEY DILLON, 
 President. 
 
 DR, BEVERLY W. SMITH, 
 Vice-President. 
 
 DR. E. S. KELLY, 
 
 Secretary. 
 
 LOUISIANA STATE BOARD OF HEALTH 
 
 DR D. HARVEY DILLON. SABINE PARISH. DR. T. T. TARLTON, ST. LANDRY PARISH. 
 
 DR. B. A LEBETTER, ORLEANS PARISH. D. BEVERLEY W. SMITH, ST. MARY PARISH 
 
 DR. HERMAN OESCHSNER, ORLEANS PARISH. DR. G. W. GAINES, MADISON PARISH. 
 DR. THOMAS A. ROY. AVOYELLES PARISH. 
 
 Extracts from the Sanitary Code of the Louisiana State 
 Board of Health, Concerning Hygiene and Sanitation of 
 Schools, with Comments by the Department of Medical 
 Inspection. 
 
 DEPARTMENT MEDICAL INSPECTOR 
 
 Medical Inspector, Dr. Sidney D. Porter 
 Associate Medical Inspector, Dr. J. A Estopinal 
 
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The following Rules and Regulations contained in the 
 Sanitary Code of the State of Louisiana embrace every phase 
 of the hygiene of person and environment that practical appli- 
 cation can require in the home and^the schoolroom. 
 
 "With a view to obtain your instant appreciation of the 
 importance of putting in practice the said regulations we have 
 followed each with such comments as may prove useful and 
 may best appeal to the lay mind inexperienced in the opera- 
 tion of the Sanitary Laws of our State. 
 
 We have every reason to expect that you may in this way 
 become thoroughly informed with just what is required of you 
 by the law which exacts that among your other duties as in- 
 structors of the young you shall include the teachings of the 
 broad, simple principles of hygiene and sanitation while keep-, 
 ing the closest possible watch over the health of the pupils 
 under your care. 
 
 Section 250 (a) which is part of Section 3, of Act 192, 
 of' the Constitution of 1908, says: 
 
 (a) "The Parish or Municipal Health Officer, and the 
 Parish or Municipal Superintendent of Public Education and 
 the Principal of the school, shall be jointly responsible for the 
 execution and enforcement of the following rules and regula- 
 tions and all health laws governing the hygiene of the school- 
 rooms under their respective jurisdiction." 
 
 No uncertainty can dwell in your minds as to the meaning 
 of the above section. 
 
 The joint responsibility of the Parish or Municipal Health 
 Officer, the Parish or Municipal Superintendent of Public Educa- 
 tion and the Principal of the school in the enforcement of 
 the regulations at once insures every probability of practical 
 
results. The union of responsibility will mean simplicity, wis- 
 dom and power — a co-ordination and co-operation into which 
 friction and confusion cannot enter— the safe, sane, only way 
 of giving movement and energy to useful endeavor. 
 
 The medical services^ so indispensible are assured in the 
 skill of the Health Officer; the health of the pupil and the 
 proper conditions of his environment are guarded daily by 
 direct and vigilant watch of the school Principal, while the 
 practical efficiency of the plan is made possible by the direction 
 and supervision of the Superintendent of Education. 
 
 Sections 250 (b) and (c). 
 
 (b) "Every schoolhouse hereafter to be erected in this 
 State, public or private, must have its plans and specifications 
 submitted to the local Board of Health to see whether every 
 hygienic detail is carried out, especially with reference to venti- 
 lation, light and protection against fire." 
 
 (c) "Every schoolhouse, public or private, or building 
 used for school purposes, shall be ventilated in such manner 
 as to afford 3,000 cubic feet of air per hour for each adult, 
 and a proportionate amount for each child, and lighted in 
 such manner as to minimize the eye strain." 
 
 Ventilation, light and protection against fire are three 
 things which mean so much that it would require volumes to 
 recount their importance. 
 
 Nothing is in so intimate touch with the mysterious springs 
 of life and health as air — fresh, pure, bracing air. The cells 
 of the blood are gluttons for it, and to be deprived of it totally 
 means for the human organism almost instant death. When we 
 give any living thing the chemical elements of which air is 
 composed we feed it and it thrives. The higher and more 
 complex the organism the greater the need of it in abundance 
 and purity. In man this necessity is foremost amid all the 
 physical conditions that surround him. The greater the abun- 
 dance in which air is served to our lungs the greater our growth 
 
physically, mentally, morally. Therefore the need of so con- 
 structing our schoolhouses that our children may spend in 
 all security within them while they are in their period of 
 greatest development an average of six hours daily during about 
 seven years of nine months each. 
 
 Of light as well as- air enough can not be said. Beside 
 
 enabling us merely to see in order to go about our several 
 occupations science has proved that light — and by that sun- 
 light is meant — is the greatest and surest of disinfectants. If 
 the rays of the sun simply emitted light without possessing 
 the powerful purifying qualities they have, the brightness of 
 sunshine would not be the universal boon that it is. It is the 
 cheapest and most potent neutralizer and destroyer which we 
 know of the causes of disease. 
 
 In his struggle against the germs of sickness man has dis- 
 covered many useful chemicals, yet as effective as they may be 
 one single ray of sunlight surpasses them all. To so build 
 our schoolhouses that the child may at all times be supplied 
 with air in abundance, and with air, light, will promote health 
 in the highest sense, and most effectively ward off disease. 
 
 Protection against fire while wholly secondary is yet of 
 too great importance to be treated indifferently. We should 
 no more trust to luck against fire than we should trust to luck 
 against sickness. The State laws governing the construction 
 of public buildings provide for every modern means known to 
 ward against the danger of fire in public buildings. 
 
 Section 250 (d). 
 
 (d) "The school premises shall be thoroughly drained, 
 and no stagnant water permitted to collect; in towns with a 
 drainage system, or where an overflow is possible, the school 
 site and the entire area of the grounds shall be properly drained 
 so as to reduce the ground water level, and the drainage effected 
 in such manner as not to contaminate with its effluvia any well, 
 cistern or other source of drinking water." 
 
 One of the unhealthy conditions with which most of us 
 are familiar is due to stagnant water. Beside exhaling noxious 
 
vapors due to rotting vegetable and animal matter, thereby 
 charging the air with an excess of moisture which even if it 
 were pure would be contrary to health, it inevitably serves as 
 the breeding place for insects and microbes that gain access 
 to the nearest building. If the schoolhouse is nearby the con- 
 sequences are self-evident. It is necessary that sunshine and air, 
 not water, flood at all times the playground of the school child. 
 If stagnant water is drained away the greatest care should be 
 observed in removing it for as it is altogether likely to- have 
 become contaminated, the danger of draining it into any depres 
 sion from which it may gain access to and poison the waters 
 of a spring, sometimes a great distance away, or a creek or 
 riv^er whose waters are used for drinking is even greater than 
 if it were left uridrained. 
 
 Section 250 (e). 
 
 Ce) "The floors of every schoolroom, together with tV 
 halls and passages leading thereto, in this State, must be swept 
 daily, except on holidays, in the following manner: 
 
 "'1. — It must be done after pupils and teachers have left 
 the building. 
 
 "2. — The floors must first be sprinkled with sawdust, mois- 
 tened with 2V 2 per cent carbolic acid or 40 per cent solution of 
 formaldehyde, or other disinfectant, as approved by the State 
 Health Officer, and enough of said moistened sawdust must be 
 ased to effectually keep down the dust. 
 
 "3. — All desks, waiscottingj window sills and basements 
 ji every schoolhouse in the State must be wiped off daily, ex- 
 cept on holidays, with a cloth moistened with formalin bi- 
 chloride, or carbolic acid solution, of a strength indicated \>y the 
 Health Officer ; and under no condition is any feather duster 
 to be used in dusting any part of the furniture or building in 
 any schoolhouse of this State." 
 
 The above regulations on the avoidance of contamination 
 with dust is of the utmost importance. Dust anywhere and 
 ^verjrwhere is a direct menace to health, whether in the church, 
 place of amusement, railway station or school, for in all o\ 
 
these places where it is not properly removed or not removed 
 at all it represents dried up organic matter of every descrip- 
 tion, particularly infected sputum teeming; with microbe life 
 capable of transmitting every variety of disease. 
 
 The greatest care should be used in removing dust. To 
 charge the atmosphere of the schoolroom with it morning and 
 evening with the use of brooms and dusters is a very dangerous 
 practice and accomplishes infinitely more harm than if it were 
 left untouched at all. 
 
 We often speak of flying dust in the street or the home, or 
 in any place of public assembly, as the "dust nuisance." This 
 is too mild a term; we should think of it and speak of it only 
 as the dust danger — the dust plague. There is no surer medium 
 of transmission for the baccilli of typhoid fever, and tuber- 
 culosis than dust scattered in the streets by the wind and in the 
 schoolroom and the home by our ancient friends, the broom and 
 the feather duster. 
 
 Flying dust is a real, not a supposed source of danger 
 founded on any theory of science. 
 
 Practical results worthy our closest attention have been 
 obtained in certain parts of the country by the removal of 
 dust in the proper way: it has been found in several of our 
 large cities that in crowded districts inhabited by the poor 
 the greatest improvemenf in health has immediately followed 
 the laying of modern pavements and the regular cleaning of 
 these with the copious use of water. What applies to the 
 street in this respect applies with equal force to the interior 
 of the home and the school. 
 
 By the scrupulous enforcement of the above regulations 
 we shall eliminate another of the great risks of infection. 
 
 In order to sweep the room in the proper way see that a 
 supply of carbolic acid and sawdust is always at hand. To 
 every gallon of sawdust add six tablespoonfuls of carbolic 
 acid mixed in a volume of water sufficient to properly moisten 
 that quantity of sawdust. 
 
Section 250 (f). 
 (f) "The urinals and water closets must be connected 
 with the sewer system where one exists, when within 1,000 feet 
 therefrom; where earth closets are used they must be provided 
 with water-tight containers, and the contents to be emptied 
 and buried at such frequent intervals as to be at all times 
 inoffensive, and not dangerous to health. Said containers, as 
 often as necessary to prevent th'e gathering of flies, must be 
 painted on the inner surface with crude petroleum and a mix- 
 ture of pulverized earth or road dust, and slacked lime in the 
 proportion of 16 of the former to 1 of the latter, plentifully 
 supplied, and the constant use enjoined. All closets must be 
 scrubbed with a disinfectant solution once a week, and kept 
 in a sanitary condition at all times." 
 
 The outdoor closet in common use in most country homes 
 and schoolhouses should be constructed otherwise than we find 
 it, if for no other reasons than those suggested by common 
 cleanliness and decency. The part it plays in maintaining or 
 destroying health is enormous. Furthermore our knowledge of 
 the role played in disease by the house-fly (in recent years 
 more properly termed the "typhoid fly") is more than suffi- 
 cient to warrant the adoption of rigid preventive measures to 
 put an end to the havoc caused by that deadly combination: 
 the house-fly and the defective closet. Our knowledge of the 
 germ-carrying proclivities of this most filthy and disgusting 
 of insects has taught us by experience that untold cases of ty- 
 phoid fever and tuberculosis have had their origin in this con- 
 stant frequenter of the exposed vault or receptacle of outdoor 
 closets. 
 
 Fully 30,000 lives are cut short yearly by typhoid fever 
 in the United States. Since we know that the fly is so im- 
 portant, a factor in its spread, equaling in this respect either 
 impure water or impure milk, how long will it be before public 
 sentiment becomes so aroused as to put in practice everywhere 
 the simple but effective teachings of sanitation? 
 
 The defective outdoor closet is not only the source of 
 
much of our typhoid fever; it is also largely responsible — 
 more responsible than any other given number of unsanitary 
 conditions combined — for the widespread prevalence in our 
 southern country of a disease due to the hookworm. The hook- 
 worm infests the excreta of its victim, and in this manner, 
 while preying on their blood until they are rendered pale, 
 dull of intellect and lazy, discharges its eggs, which upon 
 hatching, pollute the soil in the neighborhood of badly con- 
 structed closets. As the worm possesses the faculty of gaining 
 access into the blood by attaching itself to and working its 
 way through the skin, and being so minute in size as to be 
 practically invisible, we leave you to conclude the ease with 
 which it may extend its work through the agency of a defective 
 out-door closet. It is conservatively estimated by experts of 
 the U. S. Government that fully two millions of people in the 
 Southern States are incapacitated for any work on account of 
 the hookworm disease. 
 
 Section 250 (g). 
 
 (g) "The use of open receptacles for drinking water in 
 schools and of dippers or cups for common use is prohibited. 
 The school authorities must supply for holding drinking water 
 covered containers provided with faucets, which containers 
 must be scoured daily when in use. All teachers and pupils 
 must provide themselves with individual drinking cups or 
 glasses." - 
 
 There can be no greater menace to the pupil than that 
 due to the use of a common cup or dipper in the schoolroom. 
 Kemembering that all, or nearly all diseases are traceable to 
 germ life and that the route most commonly followed by those 
 is through the water we drink, it is easy to foresee and prevent 
 the evils which may result from the use of the open water 
 container and the common cup. Every imaginable sort of germ- 
 life and common filth is apt to be deposited into the "ope\< vater 
 
container by the dusty air of the schoolroom, and almost any 
 disease lurking in the mouth or on the lips of the- pupil, 
 whether sick or not, may contaminate the drinking water 
 through the dipper or cup. On account of the danger of tuber- 
 culosis, or consumption, if for no other reason, put into most 
 vigorous practice section (g) of these regulations. See that 
 you are provided with a closed bucket or cooler with faucet 
 attached end that each student is provided with his own glass. 
 Do not forget the ease with which consumption enters the body. 
 In the United States alone it is estimated that 150,000 persons 
 die of this sickness yearly. 
 
 The rigid practice of section (g) will immediately have an 
 mfluence so palpable on the health of the great body of our 
 teachers and school children that we shall observe it without 
 having to refer to comparative statistics. 
 
 Section 250(h). 
 
 (h) " Every school in the State must have a sufficient num- 
 ber of trash or garbage cans for the convenience of the pupils, 
 teachers and employees, and said trash cans or garbage cans to 
 be emptied at least once daily, except on holidays." 
 
 Garbage unremoved is only another of the many means of 
 infecting the air and water upon whose purity health is depen- 
 dent, and is at all times the breeding and feeding place of flies. 
 
 Section 250 (i) and (j). 
 
 (i) "No person suffering from any communicable disease 
 shall be employed as teacher or janitor in any public school of 
 this State. 
 
 (j) "No pupil suffering from any communicable disease 
 shall be permitted to attend the public schools of this State." 
 
 Disease in one schoolroom spreads with more rapidity and 
 certainty than does disease in a hundred homes. Let persons 
 congregate day after day in the same place, and if a single 
 one of the whole number is suffering from a communicable 
 disease the disease will sooner or later claim the whole number 
 
as its victims if no precautions are taken. From one school 
 disease may spread to a number of homes and thus on until 
 the whole population, whatever its size, becomes infected. The 
 schoolroom is the most dangerous radiating center, or focus, of 
 communicable sickness known — it is the cradle of epidemics. 
 
 Section 250 (k) and (1). 
 
 (k) '"The Municipal or Parish Health Officers should have 
 every school within their respective jurisdiction inspected at least 
 once a month, on different days, the inspection to be made 
 without previous notice being given." 
 
 (1) ''The school authorities shall provide for a medical 
 inspection of all schools, public and private, at least once a 
 month, with special reference to the existence of contagious or 
 infectious diseases, and also the condition of the eyes, ears, 
 teeth, nose find throat and general physical condition." 
 
 Practical results in disease prevention will never be entirely 
 possible until the pupils of our schools are subjected to a regu- 
 lar medical inspection, the more frequent the inspections the 
 better. In a very few of our large cities these inspections are 
 made daily. We have learned in this manner some startling 
 facts about the mischief which disease, generally speaking, 
 whether infectious or not, is playing among the school children. 
 For example, in quite* a number of the schools as many as fifty 
 per cent of the pupils were found to be suffering from some 
 derangement of sight or hearing, either congenital or acquired, 
 nearly always responsible for the child's unwillingness or inabil- 
 ity to learn. 
 
 It is a fact needing no argument and no comment that 
 the aptitude of the school child to learn depends as much if 
 not more upon his bodily health, as, for example, acuteness of 
 sight and hearing and normal state of the nose and throat, 
 as upon the manner in which the teacher delivers his or her 
 instruction. To receive into 'the schoolroom children whose 
 sight or hearing is dull or whose breathing and spee. h are 
 
10 
 
 i nc ted by some unnatural growth in the nose or throat, all 
 of which in most cases can be so easily detected, corrected or 
 removed, is one of the most potent factors in retarding the 
 development of mental activity among the young. 
 
 Section 250 (m). 
 
 (m) "The State Board of Health will, when desired by 
 the State institutions of learning, or the State Pedagogical In- 
 stitutes, or the Agricultural Institutes, send their Lecturer on 
 Hygiene to deliver a series of lectures on 
 
 ' ' 1. — Personal hygiene. 
 
 "2. — School hygiene. 
 
 "3. — Principles and practice of physical training. 
 
 "4. — Alcohol and drug addictions. 
 
 "5. — Contagious and infectious diseases — causes and pre- 
 vention. 
 
 "6. — Hygiene of the home and farm." 
 
 The above subjects presented in popular form by the Medi- 
 cal Inspectors of the Board will help remove many dangerous 
 errors so common to our mode of living — errors born of in- 
 attention or ignorance, or both, and which are responsible for at 
 least fifty per cent of our diseases and deaths. 
 
 Section 250 (n) and (o). 
 
 (n) "All schoolrooms in the State must be disinfected 
 once a week with the formaldehyde-permanganate of potash 
 mixture, as indicated in the bulletin on disinfection." 
 
 (o) "Whenever the school has been exposed to the dan- 
 ger of communicable disease breaking out among the pupils 
 or teachers the school shall immediately be closed and fumi- 
 gated before reopening." 
 
 The weekly disinfection of the schoolroom as a matter of 
 routine fulfills in the highest measure the expectations of pre- 
 ventive medicine. As.it is practically impossible to say just 
 when or how infection may enter the schoolroom, and since it 
 is apt to exist in the air of the place or attach itself on the 
 walls, the floor or the furniture of the room during a certain 
 
11 
 
 time before entering the system of its intended victims, the 
 prime and effective thing to do is to forestall its work by regular 
 weekly disinfection. 
 
 When the schoolroom is known to be infected the immediate 
 need of closing and fumigating it is imperative. To know 
 when it has been infected is therefore the important thing, and 
 here the Health Officer and Teacher working toward the same 
 end are masters- of the situation. The one unassisted by the 
 other would make the regulations impracticable. Co-operation 
 is what is sought and what is most needed. To exclude sick 
 children from the schoolroom upon the first and mildest sign 
 of trouble is no difficult feat. It requires no special training 
 to observe (in most cases at a glance) many of the external 
 signs of acute illness. The majority of these are accompanied 
 by rise in temperature and when any suspicion of fever exists 
 the use of the clinical thermometer by the teacher will decide 
 the question at once. If sick, the child is sent home and the 
 principal of the school notifies the Superintendent of Educa- 
 tion and the parents of the fact in writing. Should the 
 child's condition develop into some of the rapidly infectious 
 fevers, his timely isolation at home and the immediate disin- 
 fection of the schoolroom under the orders of the Health Officer 
 must inevitably prevent an epidemic. It must be remembered 
 that nearly all sickness being due to, microbe life, the most 
 rapidly spreading fever in the whole catalogue of disease is at 
 once rendered harmless when fought with isolation and dis- 
 infection. 
 
 Section 250 (p), (q) and (r). 
 
 (p) "All doors, except those which slide into wall pockets, 
 must be hung on double- action hinges. (See Act 73 of 1908.) " 
 
 (q) "A fire drill of pupils and teachers must be held at 
 least once a week." 
 
 (r) "Spitting on the floors, walls, etc., must be strictly 
 prohibited, and anti-spitting placards placed in every room." 
 
12 
 
 In all infectious diseases the sputum contains innumerable 
 baccilli or germs — the active agents of the infection. These 
 survive a considerable time in the expectorations even after the 
 latter have dried up and have been set free to circulate in the 
 air, mixed with every sort of filth, which finally becomes dust. 
 All that is required in order to bring about infection by the 
 germs contained in sputum is that they be suspended in the 
 air we breathe, or in the water and vessels used for drinking. 
 Spitting is, therefore, highly dangerous and should be avoided 
 altogether. But where it is impossible to avoid it every pre- 
 caution should be taken in order that it shall not contaminate 
 the floors of any place of business, or the home or the school. 
 To accomplish this the use of cuspidores must be enforced and 
 the sputum be disinfected with a solution of bichloride of mer- 
 cury, formaldehyde or carbolic acid, as per the Health Officer's 
 instructions. 
 
 Section 3, of Act 192, of 1908, creating the State Board of 
 Health, provides that it shall afford facilities for vaccination, 
 provided the same shall not be made compulsory except in cases 
 of children attending the public schools. 
 
 Reg. 88, page 25, of the Sanitary Code says: 
 "The school law in reference to vaccination as a condition 
 precedent to entry in the public schools shall be rigidly enforced 
 by the school authorities. Children shall present a certificate 
 that they have been successfully vaccinated within five years, 
 or that three unsuccessful attempts have been made with a 
 proven virus." 
 
 Dr. D. Harvey Dillon, President of the Louisiana State 
 Board of Health, in his discussion of the subject, "Vaccina- 
 tion," at the fourth annual conference of Health Officers held 
 in Alexandria in June, said: "There is one article in the 
 Sanitary Code referring to Vaccination which I am going to 
 enforce; I expect to ask the Superintendents of the Parishes, 
 the Health Officers, the physicians, and all law-abiding citizens 
 to help me in the enforcement of this law." 
 
13 
 
 Vaccination is a positive protective measure against small 
 pox, and in our campaign of educating the people to the impor- 
 tance of vaccination in preventing and stamping out small pox 
 we should have the co-operation of all the people who are doing 
 educational work in any line on this subject for the public good. 
 
 Vaccination when properly done, under the proper anti- 
 septic precautions, by a well-qualified medical man, is absolutely 
 void of danger. 
 
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