RURAL SCHOOL HYGIOT3 
 
 A Section of the Pennsylvania Rural School Survey 
 By Professor Louis W. Rapeer, Pennsylvania State Cbllege 
 
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 Jjl§. Pr oblem . The writer of this seotion of the survey report is 
 new to the state, has been ever-burdened with other duties, and 
 has had no time at his disposal to make a thorough-gjing investi¬ 
 gation c.f rural school hygiene in Pennsylvania. Visits with a 
 medical inspector to a few schools in the state, traveling in many 
 parts of the state where rural schools could be seen from the out¬ 
 side, conferences with county superintendents, with the'State Super¬ 
 visor of Rural School Medical Inspection and Sanitation, and with* 
 the State Superintendent of Public Instruction, and with teachers 
 at institutes, a study of the school and health codes, and the 
 generally available data on rural school hygiene have furnished the 
 immediate basis, for the following generalisations and recommend¬ 
 ations. The inadequateness of the study leads to the first recom¬ 
 mendation that a committee be appointed by the Association to con¬ 
 tinue the investigation and to promote educational publicity with 
 respect to rural school health improvement, including the follow¬ 
 ing phases: Medical Supervision, School Sanitation, Physical Edu¬ 
 cation and Recreation, The Teaching of Hygiene, end the Hygiene 
 of Methods of Teaching and Management. The seriousness of the pre¬ 
 ventable dea.th and illness losses of the peorJ 3 in the country 
 districts’" (Footnote.- * There were 54,249 deaths in the rural 
 districts of Pennsylvania in 1912, probably 2d,000 of wh„,ch were 
 reasonably preventable.^ as well as the pro -alence of physical 
 defectiveness and The lack of recreation make further study and 
 widespread health education of old and young imperative. 
 
 GENERAL ADMINISTRATION 
 
 Prese nt Rura l Sch ool Health Co nditi on s. The oecords of our State 
 "Board of Heal oh show {hat the problem”of health in the country is 
 as serious at least as in the city. In fact, he difficulties of 
 promoting health and normal recreation for th i entire population 
 i'.n the rural regions o.re in several ways more d iff ion; i that in 
 our largest cities. The recent c undies of Dr. Thor.. D- hod and 
 an examination of the returns of the medical and sanitary inspect¬ 
 ions of the rural schools of this state indicate nhat the health 
 status of the rural school pupils is no better than that of ei ’ey 
 chnl.tlren for whom there have been collected abundant statistics. 
 
 Where there hove not been veritable crusades of corrective meas- 
 % ures it will probably be found in any one school year that about 
 •» ore-third of the rural school children are free from serious ail¬ 
 ments and defects, that about one-third have dental defects 3nly, 
 and that at least another one-third have dental and other defects 
 of a more or less serious character including infectious diseases. 
 
 The actual findings if the medical officers with respect to the 
 health conditions of the children and the sanitary conditions of 
 

 
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 the rural school buildings and grounds are given on pages and 
 . Data with respect to the number of school houses in good 
 and bad sanitary condition are given «n page . Yi/hile the avail¬ 
 able data are relatively inaccurate and meager, yet we must con¬ 
 clude that, considering the seriousness of the large preventable 
 death, illness, and physical defectiveness rate and the opportun¬ 
 ity before the rural school to ameliorate conditions, the health 
 and recreational facilities of the rural schools are on a low 
 plane of efficiency, not as low as many states but low enough to 
 warrant the serious concern of all oitizens, and especially the 
 health and educational officials. 
 
 Medical and Sa nitary Inspe c tion . The State Board of Health furn¬ 
 ishes medical and sanitary inspection of such rural schools as 
 are not exempted by a majority vote of rural school directors and 
 a notification to the State Board of Health before the firs'; of 
 July each year.* (Footnote—* See School Code, sections 1505-4.) 
 
 A large majority of the rural schools are now using this service. 
 
 In this they are ahead of most rural schools of the nation, com- 
 X . ’.lively few of which have even the primary, onco-a-year inspect¬ 
 ion. by physicians. Our physicians are paid six dollars a year 
 for each class-room of children inspected and they make about one 
 vie Lt a year to each of several, schools, sometimes returning to a 
 school to insnect children missed at the firs* - - yi w it. A few of the 
 more altruistic give more time. The average amount of time spent 
 in a classroom is probably near two to three hours. The physician 
 sometimes adds to his medical and sanitary inspections through 
 teaching hygiene by means of a short talk to the children and teach¬ 
 er. The opportunity in the field of preventive medicine is great 
 but the slary is very small and the social , crvice standards of the 
 physician are frequently not much above those of the trades-people 
 with whom he is surrounded. After making the inspections, a report 
 is sent to the State Department of Health which later notifies par¬ 
 ents of defects found. Complaint is made that these reports have 
 ruached paints too long after the inspection but this defect is 
 now being remedied. Teachers are not yet Ising supplied with a 
 copy of the report of uhe defects found and consequently cannot 
 w r 11 make up a historical record card for each pupil nor follow-up 
 end got cured the ailments found. The Department of Health is now 
 planning to furnish each beacher with such a life card for each 
 pumLI, to contain both the health and scholastic record tlrrougnout 
 the eight grades uf school life, or through the high school. The 
 inspections seem fairly well done considering that the physicians 
 have received no special training for the work and have practically 
 no supervision. That it is superficial goes without saying, bus 
 fit most of the serious ailments and defects are found is fairly 
 certain. The merits and demerits of the system are about as folia vs. 
 
 M eri ts 
 
 1. It is a start toward better things. 
 
 £. ft brings to the attention of parents probably ninty per cent, 
 of the serious ailments and defects of children. 
 
 3. It calls the attention of teachers and pupils each year to the 
 
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 importance of health and correction of defects. 
 
 4. It discloses certain had conditions of sanitation and fre¬ 
 
 quently gets them improved. 
 
 5. It has given us a health and sanitary survey of the rural 
 
 schools, setting forth more or less accurately the actual 
 conditions. 
 
 6. It has aroused a small percentage of parents to a sense of 
 
 their responsibility for caring for the health of their 
 children through preventive and remedial measures. 
 
 Demerits 
 
 1. It succeeds in collecting many statistics of pathological con¬ 
 
 ditions hut fails quite largely in getting cures, cor¬ 
 rections and preventive measures. 
 
 2. The inspections are entirely too infrequent, thus failing to 
 meet the problem of epidemics of infectious diseases. 
 
 3. Inspection is not mandatory, by law, as it is in first, second, 
 
 and third class districts and in other entire states. 
 
 4. The system fails to provide corrective agents and measures, 
 
 such as nurses with large powers and clinics, and fails 
 to enforce either sanitary or medical recommendations 
 upon school directors and parents, even in so simple a 
 matter as vaccination. 
 
 5. Probably the greatest weakness is in the meager sco;-e and 
 
 quality of educational publicity along wealth lines. 
 
 Rural people are isolates and conservative. "They must 
 be shown,” Educate the people and they will more gener¬ 
 ally respond to the recommendations of the physicians. 
 
 The department could Y/ell use fifty or more lecturers to 
 meet the people in a modern way at the rural school social 
 centers. The school department is likewise weak in this 
 respect. Teachers do not do what they can to learn 
 mere and to do more along school health lines. The key 
 to school healtn progress is school health public! by, 
 
 6. In this connection, the department is very weak in not hav¬ 
 
 ing several trained rural school nurses for each county. 
 ITurses have so far proved the most efficient and economical em 
 
 cational agents in cities and they hrve proved very effect¬ 
 ive in the rural parts of other state . The department 
 is contemplating a trial of rural school nurses. 
 
 7. The system is not a part of the educational department of the 
 
 state in any direct way. The physicians are looked uuon 
 as outsiders and are not given the support they would re¬ 
 ceive were they employed by the county superintendents 
 or the State Department of Instruction. Medical and san¬ 
 itary inspection are not made an organic part of eduortion- 
 hygiene and the isolation of the parts is a serious cause 
 of inefficiency. 
 
 8. The physicians are employed on -part-time. School medical 
 
 inspection is for "them a side-issue, a thing to be done 
 not as a Mfe work and a speciality but as a moons of 
 taking in a little extra money when patients are few. 
 
 There is no opportunity to specialize in this new and 
 technical type of work, except for the one supervisor in 
 the State Board of Health office at Harrisburg, Dr. Royer. 
 
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 1 Perman ent Solut ion. School health work must he treated as 
 a whole with at least these five divisions:- Medical Supervis¬ 
 ion, School Sanitation, Physical Education, The Teaching of 
 Hygiene, and the Hygiene of Methods (of Teaching and Management). 
 The isolation of these phases and the lack of officials respons¬ 
 ible for the whole health field ore now the most important 
 causes of school health inefficiency. 
 
 To effect this organization and unity of endeavor, and to 
 promote financial and human economy, the state administration 
 of medical and sanitary supervision must he in the hands of the 
 State Department of Public Instruction; the county administra¬ 
 tion must he carried on by the county superintendent and, if 
 provided, by the county board of education. Such organization 
 would make possible the employment of a supervisor of hygiene 
 for each county and a corps of school nurses to take the place 
 of the part-time physicians. Pour to six school nurses to a 
 county on full time under the supervision of a physician~phy- 
 sical-educator on full time, all under the general administration 
 of the county and state educational departments, would accom¬ 
 plish probably a thousand times more for the improvement of 
 rural life and rural schools than the present arrangement, and 
 more than a similar amount of money spenv along present linos 
 would bring about. The State Department of Instruction would 
 thus be'enabled to employ an educational hygienist to supervise, 
 inspire, and promote not only health, physical development, end 
 recreational agencies in the country (fourth class districts) 
 but in districts of the first, second, end third classr All 
 districts need such help and stimulus. Medical inspection has 
 been taken out of the hands of boards of health in Hew York, Hew 
 Jersey, and Massachusetts, and to a considerable extent in Penn¬ 
 sylvania; three of the above states will soon have educational 
 hygienists in the state educational departments for general 
 supervision of the physical and he: 1th side of the education 
 of children so long neglected; and Pennsylvania should proceed 
 along the same line of evolution. 
 
 In a county, the supervisor of educational hygiene should 
 take the rank of an assistant county superintendent. His salary 
 should be not less than $2,000 for full time. Assisting him. 
 there should be in each county a number of district nurses, 
 each nurse taking as many schools, regardless of townsh.ip lines, 
 as possible, probably not more than fifty classrooms to begin 
 with. Rural school nurses, with their Fords and buggies, are 
 now doing superior work for rural health in a number of states. 
 Four nurses to a county, as a beginning, with salaries at ti'ChOG 
 a month would cost, for eight months a year, $2,240, not < cant¬ 
 ing supplies nor the use of conveyances if provided by the 
 county. The cost would bo about equivalent to the silavi.es of 
 two assistant county superintendents, and should be borne by 
 state and county appropriations. This is, ultimately, the most 
 convenient, efficient, and economical organization. -bulled 
 

 
 
 
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 nurses under supervision, working as regular school officers, 
 ore the most effective means of translating pathological statis¬ 
 tics into cures, corrections, and prevention of disease. The 
 work of the supervisor would be to lead and to direct all school 
 health work along the lines of the teaching of old and young the 
 tfwao/s and means to health and joyous living# He would use the 
 /rural school as a health social center, meeting the parents fre- 
 q uently at such centers; he would organize md promote the -ley 
 land recreational activities of the schools and oonimunities; he 
 would help get schools and grounds into sanitary condition; he 
 would help bring about consolidation and transportation of pupils 
 where desirable; he would help examine the children medically and 
 physically; he would help get cures, corrections, and preventive 
 measures for ailments and defects found; he would establish and 
 manage "flying" or traveling clinics for treating and prescrib¬ 
 ing for moor children; he would train the nurses and teachers for 
 their work. 
 
 Legislation would, of course, be necessary to provide such 
 organization. The enormous preventable death, illness, end phy¬ 
 sical defects losses of the rural population, probably not loss 
 than forty million dollars each year when estimated m money, make 
 imperative a more energetic and civilized method of ameliorating 
 disgraceful health conditions. 
 
 IMPROVING TEH PRUSRNT ORGANISATION OF RURAL 307X001, HfCrlUNT 
 
 If a thorough-going reorganization of rural school health 
 work is not at present feasible , much can at least be done in 
 improving the present system. The State Board of Health must 
 have much larger appropriations for this work so it can introduce 
 school nurses and other improvements; the provision of medical 
 and sanitary inspection must be made mandatory for all school dis¬ 
 tricts; teachers, principals, and enunty superintendon bo must 
 have a much improved training along the lines of oduo.o bional hy¬ 
 giene before and while in service; and the work of rhe nl;ato De¬ 
 partment of Instruction along the lines of school health work 
 must be greatly extended. 
 
 Tlie State Department of Publ ic Instruction.^ The State Deportment 
 of Public Instruction should" have" on its staff an educa tional hy¬ 
 gienist who would help the Department to educate the ueople with 
 res-ect to healthful living, including the teachers and ^unils, 
 to supervise the work to some extent, to enforce health measures, 
 and to put back into schooling what has been ommitted since the 
 time of the Greeks. Further suggestions are as follows 
 
 1. The state department should begin at once to furnish bulletins 
 on the various phases of health work such as play and playgrounds, 
 school sanitation, standardization of rural schools, the teach¬ 
 ing of hygiene, the teacher T s responsibility for medical inspect¬ 
 ion and fo'llow-um of school children, etc. , such as are furnished 
 to all rural teachers in Oregon, Virginia, North Carolina, and 
 other states. These should be well illustrated, printed in large 
 attractive tyne, and written in succinct, readable stylo. 
 
 2. Iu should make the course of study in hygiene for elementary 
 and high schools ns helpful both as to content and method as 
 
 possible. 
 
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 So It should v)lace on the list of required reeding: for teachers 
 such "books as Hoag and Terman’s recent volume on "Health Work in 
 the Schools" and Curtis’ "Play and Recreation in the Open Ceuu-- 
 try. " 
 
 4. The school code should "be "bolstered up in sanitary and other 
 health requirements, and the penalties for not complying with 
 the law, such as removal from office by the State Superintendent, 
 and by withholding appropriations should be increased. These 
 powers should be frequently used until new standards are estab¬ 
 lished. 
 
 5. Models of rural schools of vo.rious sizes, including consol¬ 
 idated schools, should be made in cardboard or other material and 
 loaned to directors, institute lecturers, and county superintend¬ 
 ents, Printed plans and photographs of desiro/ble buildings 
 should be sent broadcast to elevate the standards of what the 
 
 rural school plant should be. Standards and premiums in the 
 shape of door plates or certificates should be set up. Descript¬ 
 ions of the great development of consolidated schools would 
 klip in the same direction. 
 
 6 School health exhibits should be made up by the state deport¬ 
 ment and sent out to institutes, normal schools, directors'* meet¬ 
 ings, and other places to raise standards along all lines of 
 school hygiene. 
 
 7, It should also furnish health bulletins and news items to 
 teachers, news agencies, directors, superintendents, and others 
 as the U. 1. Bureau of Education is now doing. 
 
 8. The State Department of Health should be "backed up IT by ail 
 the newers of the State Department of Public Instruction 
 
 C5parity. Admi nistrat io n . Even with the general administration of 
 
 medic?1 and sanitary inspection in the hands of the State Boa’s: 
 of Health, a great work remains to be done in each county, \<v . 1 
 school nurses should by some means be provided, They may well 
 be under the supervision of the county superintendents cl no 
 county hygienist is provided. The State Boarc. of Heal kh mig t 
 meet the situation by uniting the offices of county heal Lb of¬ 
 ficer and county school hygiene supervisor, such a man on full 
 time and with a good salary could do for run ..l health a great 
 public work. The difficulty would be in getting firsu-clasa 
 officials and the right kind of co-operation between couuby 
 superintendenbs with their many teachers and the school and 
 health officer* This, however, seems to be the logical and econ¬ 
 omical stem in advance with the start we have taken. 
 
 County superintendents should report on the health condom 
 ions uf Uheir counties as city superintendents do and iiurr hi cal ! 
 use every means to help and co-operate with the health officials- 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 The_Stt te School Law. The following suggestions are offered 
 for improving the school laws with reference to rural school 
 hygiene:- 
 
 1. Hake medical and sanitary inspection in fourth-class dis¬ 
 tricts mandatory instead of permissive ns at present. 
 Provide for more universal enforcement of the vaccination 
 law. It is now largely a dead letter in rural schools 
 in many parts of the state. The State Commissioner of 
 Education of New York is using his power of removing 
 school directors from office for non-compliance with this 
 law. State school appropriations, amounting to about 
 •$75,00 for each teacher and $1.80 for each pupil in the 
 district between the ages of six and sixteen inclusive, 
 should be withheld for non-compliance with certain defin¬ 
 ite laws such as those for vaccination, jacketed stoves, 
 proper lighting, suitable outbuildings, provision of 
 drinking water, etc. More effective educational publicity 
 will obviate very frequent recourse to such measures. 
 Section 616, respecting the preparation and free distribution 
 *£ plans for model soho-ol buildings by the State Board of 
 ''Pd.uca^ioii, is a very good law but it, is not being followed 
 up very effectively. Prowisiond for educating the public, 
 especially teachers and school directors, as to the desir¬ 
 ability of improved standards for the rural school plants 
 (buildings and grounds) should be increased. 
 
 Section 618, respecting the provision of a lighting area equal 
 to at least one-fifth of the floor area and no light from 
 the front, should be amended to require also a preponder¬ 
 ance of lighting area #n the left of the pupils as seated 
 at their desks and to provide for automatic withholding 
 of state appropriations from each school in use after 
 January first, 1916 that is not in conformity with the 
 law. A rural school in Columbia County recently added 
 two windows on each side of a rural, •ne-room, brick school 
 at a cost of only $30.00. Two windows added to the left 
 of the pupils v/ould have given e lighting area equal to 
 more than one-fifth «f the floor area and a preponderance 
 of light from the left. The cost of such changes is 
 evidently insignificant, considering the improvement in 
 the cheer of the class-rooms and the lessening of eye- 
 strain which now increases progressively upward through 
 the grades of school life. 
 
 be amended t* require an average temper¬ 
 ature in schools of 68 JnA head of 7i degrees Fahrenheit 
 Section 62^ should: frfbTTTcTe' for a hy grome ter in each school 
 building as well as a thermometer in each classroom. Re¬ 
 cent investigations which indicate that neither insuffic¬ 
 iency of oxygen nor increase of^carbon dioxide are import- 
 
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 ant factors in ventilation, lead to an emphasis on humidity, nr 
 percentage of moisture in the air, in school ventilation.* (Foot¬ 
 note See Hill's pamphlet nn "The Relation of the Atmosphere 
 to ^ur Health" published by The Smithsonian Institution, Wash¬ 
 ington, D. 0. and Termcn's chapter on "The Physiology of Vent¬ 
 ilation" in his book on "The Hygiene of the School Child.") 
 
 All teachers teach that oxygen and carbon dioxide are the princi¬ 
 pal factors but the important factors really seem to be: percept¬ 
 ible movement «f the air, proper temperature (around 68 degrees), 
 suitable percentage of moisture in the air, 4^ to 7* per cent, 
 and elimination of disease germs, especially the first three. A 
 direct reading hygrometer such as the small "hair hygrometer" 
 with thermometer attached or the "precision hygrometer" with a 
 face like an alarm clock and the hair well protected should be 
 usee 1 . (Footnote:- * May be purchased from the Central Scienti¬ 
 fic Supply Co., Chicago or other dealers for five to seven dol¬ 
 lars each. The prices seem variable. ) With such an instrument 
 a teacher can tell the percentage of moisture as easily as she 
 can tell the time by a clock. When the moisture in the room goes 
 below, forty per cent *f saturation, she can (a) open windows to 
 let in outside air, (b) put water into the receptacle for such 
 rrumose os provided with jacketed stoves, or (c) place a pan or 
 pans of water on the stove or radiators, fin days when the humid¬ 
 ity is well above forty per cent no water need be used. When 
 teachers or pupils have to carry water from farm houses up to a 
 mile away this would be a saving of energy during a large part 
 of the year. The excessively dry air is very harmful and many 
 schoolrooms have sir as dry as the deserb of Sahara, and dryer, 
 much of the time when the room is being heated artificially. 
 
 Windows may be used to orovide a distinct movement of the 
 air. Window boards or glass should be used to keep strong 
 drafts off the nunils near the windows. Some teachers fail to 
 keen the fresh air vent into the jacket of the stove «pen at all 
 times. This should- be prevented in most cases, perhaps, by 
 making it impossible to close the vent at ail. 
 
 7. Section 624 should be amended to provide not only that all 
 doors of schools should open outward but that all such doors 
 should always be un locked while schools are in session. It is 
 common to see tw# doors together (double doors) in village 
 schools, with one of the do*rs locked shut at all times. Such 
 doors should be provided with panic bolts which open the doors 
 by slight pressure by a small child. Many of the 17? children 
 who were burned to death in the Collinwood (Cleveland) fire lost 
 their lives because there was no panic bolt on one «f the double 
 doors so it could be opened outward. 
 
 8. A section should be provided to insure plenty of fres h drink¬ 
 ing water on the school grounds at all times while schools are"* 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 in session, and to provide that where water is not obtainable 
 at a distance of a hundred yards from the school grounds that 
 the directors be required to haul fresh water to the school daily 
 or provide a well on the grounds. Where the expense of providing 
 several wells in a district is great it may be f^und more desir¬ 
 able to establish a consolidated school. (County administration 
 and consolidation of schools are both irmortfnt factors in school 
 health orogress.) 
 
 The Health Education of .Teachers. The courses in general hy¬ 
 giene in* our elementary and high schools should be improved in 
 the direction #f more time, better teachers, and better texts. 
 Practical personal, public, community, and occupational hygiene 
 should be taught, not merely for giving health information but 
 for developing workable health ideals and habits. The large 
 number of persons going directly from the high schools to the 
 classrooms as teachers may well have special training along the 
 line of school hygiene in the high schools. 
 
 For the graduates of our normal schools t* go out as rural 
 school teachers without a thorough-going study of rural life and 
 education and a similarly thorough course in rural school hygiene 
 is little short of criminal, considering the demonstrable needles* 
 deaths and illnesses due tj ignorance of practical school hygiene 
 on the part of the teachers. The simple essentials of medical 
 su-- ervision, school sanitation, physical education, the teaching 
 of hygiene, and the hygiene of methods of teaching and man agomen c 
 can be treated in a course one term in length, meeting five hour;; 
 a week, and this should be a required minimum. Hoag and Terman's 
 "Health Work in the Schools"* (Footnote:-* See list at end of 
 this section.) cover three of these phases. Curtis' book on 
 "Play end Recreation in the Open Country" deals with physical 
 education, including play and recreation. Dressier 1 s book *n 
 "School Hygiene" is devoted largely to school sanitation. No one 
 book covers all five divisions except "Educational Hygiene" be¬ 
 ing published by Scribner’s for the writer, which is rather large 
 for a normal school class perhaps# Gillette’s "Constructive 
 Rural Sociology" end the various books on rural life and rural 
 education named on page give many helpful suggestions along 
 the lines-of practical educational hygiene in the home and in th* 
 school. 
 
 _The Teacher ’ s Own H ealt h is of supreme importance in education. 
 
 In their professional training and while in service they should 
 be acquainted with the facts regarding the health of teachers, 
 such 83 are given in Terraan r s "The Teacher’s Health" and else¬ 
 where. Teachers as a class have more of tuberculosis, nervous 
 ness, and ailimentary diseases than the average population. Ev 
 thing possible should be done to make them healthy, vigorous, 
 and joyous, as becomes those whose work is with children and. wKt 
 as public officials of the state must be held responsible as gu 
 guo.rdians of the public health. 
 
 Teachers should be medically examined each year by the 
 physician who makes the medical examinations of the school 
 

 
 
 
 
 
 
 
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 / children. At present a teacher in any state of ill-health, it 
 seems, can obtain the health certificate that is required each 
 yjear. For the purpose of learning of incipient ailments each 
 •Jjeacher should on her #wn initiative ask to be examined each 
 /year by the examining physician. It is a right and a privilege. 
 j The life Extension Institute ®f New York is now examining thous¬ 
 ands of employees of industrial concerns for employers, without 
 j expense to the employees, for the purpose of increasing their in- 
 ' dustrial efficiency. (Footnote:-* See article by R&weer in 
 Educational Review for December, 1914.) The state has an even 
 greater warrant and obligation with respect to its public of¬ 
 ficials in the public schools. 
 
 Every teacher, m©re©ver, should have an avenue of appeal that 
 will prove effective when she finds herself immured in a school 
 plant that is unsanitary and injurious to her health. An appeal 
 either to the State Department ©f Public Instruction, the S ka r ;e 
 Department of Health, or t« a committee of the State Educational 
 Association should bring prompt and effective relief frcm such 
 conditions without Jeopardy to her tenure of office. 
 
 It may be f#und desirable to provide teachers with social 
 insurance against sickness and injury while at their work. 
 
 Schoel Health Ha ndboo ks. A selected group of school health hand¬ 
 books for teachers, superintendents, physicians, and nurses is as 
 f allows:- 
 
 Allen, "Civics and Health” 
 
 Bancroft, "lames f©r Playground, Home, School, and Gymnasium." 
 Cabot, "Volunteer Work in the Schools." 
 
 Burk, "Health and the School." 
 
 Coleman, "The People r s Health," for upper grades and high schools, 
 Cornell. "Health and Medical Inspection of School Children.” 
 Cruickshank, "School Clinics.” 
 
 Curtis, "Play and Recreation in the Oven Country," 
 
 Chisholm, "The Medical Inspection of Girls in Secondary Schools." 
 Denison, "Helping Scho©l Children." 
 
 Hitman, "Home Hygiene and the Prevention of Disease," for home 
 and school. 
 
 Foster, "The Social Emergency," a botk on sex education and hygierw 
 Gulick and Ayres, "Medical Inspection of Schools." 
 
 Gulick series of hygiene texts for elementary schools. 
 
 Hoag and Terman, "Health Work in the Schools.” 
 
 Johnson, "Education by Plays and Games." 
 
 Raneer, "Educational Hygiene," fin press) 
 
 Pwaoeer, "School Health," a hanbook for teachers, fin preparation, 
 Rapeer, "School Health Administration." 
 
 Ra^'eer, "The Administration of School Medical Inspection." 
 
 Ritchie hygiene series f#r elementary schools. 
 
 Perry, "The Wider Use of the School Plant." 
 
 Sill, "The Child," go*d f©r the home as well as .lower grades in 
 school. 
 
 Terman, "The Teacher r s Health." 
 

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 Terman, "The Hygiene #f Instruction" fin preparation) 
 
 Terman, "The Hygiene tf the School Child." 
 
 Tolman, "Hygiene Tor the Worker." 
 
 Wood, "School Sanitation." fin preparation) 
 
 Besides these books there are many free pamphlets issued 
 by the United States Bureau of Education and by various state 
 boards of health and boards of education, procurable for the 
 asking. Kingsley’s book on oven air schools, entitled "Open 
 Air Crusaders" may be obtained free of charge, or for the post¬ 
 age, from The Elizabeth McCormick Memorial Fund, Chicago. Any 
 teacher can build up a free library on most phases of education¬ 
 al hygiene for her school or herself with little trouble. 
 
 Some miscellaneous recommendations growing out of visits to 
 rural schools and conferences with medical officers and county 
 superintendents follow* 
 
 Medi cal Sup ervis ion. Sufficient suggestions have been made in 
 this field perhaps for this time. Hoag, in his bulletin on 
 "Organized Health Work in the Schools" shows how teachers may 
 learn to discover over ninty per cent of the ailments and de¬ 
 fects of their children.* (Footnote:-* Government Printing Of¬ 
 fice, Washington, D. C., price ten cents. The substance of this 
 bulletin is also in his "Health Work in the Schools.”) Teachers 
 can also do very much by daily health questionnaires and heme 
 visiting, almost equalling a good school nurse in getting cures 
 and treatments of ailments found. While physicians and nurses 
 are not at the school, teachers must be held responsible for de¬ 
 tecting infectious diseases. Hoag's symptom charts will help 
 in this. By use of the rural school as a social center parents 
 may be taught directly by stereopticon and other lectures. 
 
 State College is preparing slides for such use- to loan to schools. 
 The Russell Sage Foundation of Hew York will loan slides on play¬ 
 grounds, medical inspection, and other similar topics. Visit¬ 
 ing nurses' associations end rural Y. H.- C. A.'s may fften be 
 appealed to successfully for the loan of medical tr playground 
 workers. 
 
 School Sanitati#n._ The demand for unilateral lighting of schools 
 
 has probably gone to* far. Unilateral lighting eommcnly means 
 unilateral windows, and windows on one side of the classroom, or 
 even st left and rear, mean that the opportunity f#r perceptible 
 air currents in the room is cut off. The shadows of the pupil’s 
 hands on their writing, on the right side of the room- are prob¬ 
 ably insignificant in injurious effect as compared with- insuf¬ 
 ficient ventilation, especially in one— room rural schools, and 
 especially when the ventilating apparatus is poor or is not in 
 use. By cutting two or three windows more through the left wall 
 of the one-room school and leaving the present windows on the 
 right for illumination and ventilation mos’c rural sohools can 
 be given glass space equal to one-fourth of the floor space,. a 
 

 
 - .<*■> 
 
 
 
 
 
 
 
 
 
 
 
 
 
 / 
 
 . -' 
 
 • **»#»* 
 
 -■ -*KU&* P 
 
 - •••, . •. S"W 
 
 - e«. ' 
 
- 12 ' 
 
 desirable proportion for a. room twenty-three t# thirty feet in 
 width. Schools with halls should els* have windows -jri the 
 right tf punils, for light and ventilation. High single sash 
 on oivots are satisfactory. 
 
 Cr^-ss ventilation may he secured by the use *f window boards, 
 about five inches in width, the width of the window sash, and 
 sowed in two and fastened together by a hinge to make removal 
 easy. Such a board can be made in twenty minutes by any handy 
 school boy of the u-oper gra.des, and moreover furnishes first- 
 class manual training work. The board should be inserted be¬ 
 neath the sash leaving the air to come in between the sashes at 
 the middle of the window. Wider boards at the bottom cut out 
 too much light. One or more such boards should be used with 
 even the best tyres of jacketed stoves, I believe. During mild 
 and warm weather the room should be made an open air school, 
 children keeping their wraps on when necessary. 
 
 Dark green window shades seem almost universal in rural 
 schools but they should never be used exceot f r r the use of lant¬ 
 erns in the day-time. Many teachers have the bad habit of keep¬ 
 ing shades drawn half way even on cloudy days, thus cutting rff 
 more than half of the light. Shades should be light tan in 
 color and should be translucent, cutting off the blinding rays 
 of the sun but permitting enough light to shine through to keep 
 the room well illuminated. Dark shades frequently make a room 
 cave-like when shades are nulled down t§ cut out the direct rays 
 of the sun. The injury done by careless teachers who leave 
 shades pulled down when the sun is not shining in is lessened 
 by the use of such light colored translucent shades. The Luther 
 0. Draper adjustable, translucent, cloth shade as used in the 
 high school building at State College seems to fulfill most con¬ 
 ditions of good shades at small cost. Other good shades will be 
 found advertized in the Sohool Board Journal. 
 
 Statistics given later and the writer r s *wn •bservations 
 show that lighting from in front *f the pupils is still permitted 
 in a number of schools. These windows should be immediately 
 closed. Appropriations should be withheld and prosecution 
 should follow if necessary. 
 
 Lighting in the rear #f pupils should not be strong enough 
 to injure the eyes tf the teacher. Small high windows have 
 ■’-'roved satisfactory, or long windows with colored glass or cur¬ 
 tains for the lower sash. 
 
 Fiunip;: tion of schools by means of formaldehyde or other chem¬ 
 icals is probably unnecessary and wasteful. The State Board of 
 Health officials of New York have recommended soap and water 
 cleaning instead. In fact, cleaning and sunlight are gaining 
 rapidly in favor with experts in this field over older methods 
 of disinfection that have been' brought in during the past fifty 
 
- " "> •. 
 
 
 
 
 
 
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 ‘'.‘'J" '• r ' :f 
 
 
 
 
 
 
 
 
 
 
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 y 
 
 
 
 
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 *««*•*• ' -v >» - • 
 
 
 
13 - 
 
 years. Fumigation has been aptly called "burning insence to 
 to *ur superstitions." It may, however, be necessary in some 
 cases merely to allay the fears of parents, but soap and water 
 scrubbing should accompany it. 
 
 I have seen rural schools full of flies in my visits. 
 
 Desks were covered with remains of pupils’ lunches and the 
 warmth of the room kept the flies alive till late in the fall. 
 
 Such teachers may teach the spread of infection by flies when 
 they come to the subject in the hygiene text-book while by their 
 neglect they may be spreading disease. A few five cent swrtiers, 
 or screen wire nailed on sticks by the boys, or a little sweep¬ 
 ing of the ceilings on cold mornings would have eliminated 
 these disgraceful pests. In one case the flies were so numerous 
 that one to three or more could be seen on each piece of pie f nd 
 other food that children were eating; and yet a county superin¬ 
 tendent had visited the school without comment a short time 
 previous to my visit. It would seem that a campaign of school 
 health education for comity superintendents might be an econom¬ 
 ical and desirable approach to the rural schooi health problem. 
 
 An examination of the statistics gathered in the annual 
 rural school sanitation survey as given later will show the need 
 of further measures along lines of sanitation. Dreat care should 
 be taken in providing sanitary privies. Point should have sand 
 scattered evenl?/ - on it while fresh so markings will be prevented. 
 There is a striking dearth of paint at most rural schools of 
 frame construction. 
 
 Physical Education. Play and recreation in the country are much 
 needed by old and young. The rural population in many counties 
 of Pennsylvania is actually decreasing and far too many of our 
 youth find the farm a dull, sordid place of all work and no play 
 and are leaving it for the cities. The rural school should meet 
 or help meet the needs of rural life and it hern a fine opportun¬ 
 ity at this point. I need but suggest the value of Curtis’ book 
 on Irp lay and Hecreati#n in the Open Country” at this point. 
 
 Many recreative and educational games and plays should be taught 
 country children; apparatus for play should be on every rural 
 school ground; the rural school should be made an evening re¬ 
 creational center for old and young; and a more joyful spirit 
 should pervade the school life. A teacher who will not get *ut 
 on the playground at recesses and play with the pupils is ^nly 
 half a teacher. For her own health and poise, and for better 
 attainment of the goal of life she should regard play as an op¬ 
 portunity. Play should be a part of every course of study and 
 teachers should be trained and tested along the lines of play, 
 games, recreations, calisthenics for the classroom, the construct¬ 
 ion and use of play apparatus. 
 
 No teacher should go into the schools from normal schools 
 who does not understand how to lead in folk dancing. By the use 
 of movable school chairs instead of desks screwed to the floor 
 the classroom can be put to most of the uses of a small gymnas¬ 
 ium. If the rural school is to be used as an evening social and 
 recreation center there is no reason, except the narrow pre¬ 
 judice and traditions that are driving boys and girls from the 
 farms, to keep ftlk dancing out of the rural school for the youth 
 
•o.. 
 
 >4 li rc ’ r rrrsid n be£l ; 3o v.£$ci& need s&ii tt*Co2%jjzx’'i' ,h ^ :;9 •■ 
 
 J aauo.u gii-.ij.j- ^ ^___-v 4. 1 n , c> r -« :-->• c-.-.r, ; r „ ,-fro -«•'•- r -*■ 
 
 
 -<*: 
 
 
 3 i BJKi stc.o : ' — ; ’ - * ! : * 5 ;’. 
 
 zosd -i‘ ^ - ■" — ; 
 
 p , - ' /N r 
 
- 14 ~ 
 
 and adults of the neighborhood. City schools have long had 
 such advantages. One hig reason frr the consolidated school is 
 the letter opportunity it affords for such a social and re¬ 
 creation center with youth in attendance in sufficient numbers 
 to make some social life possible. To eliminate the prejudices, 
 we need wise guidance and publicity. Demonstrations may well 
 be held at every county institute. The use of pictures of 
 children and youth engaged in such plays, games, and dances will 
 do much, to make them gain in favor. Let us lead and educate 
 the people rather than attempt merely to drive them by legis¬ 
 lation. Legislation is good but education is better. Both are 
 desirable. 
 
 Specially helpful free, or free for the ptstage, bulletins:- 
 Curtis, "The Reorganized School Playground" (ten cents), Sunt, 
 of Documents, Government Printing Office, 'Washington, D. Co 
 State Board of Education of Oregon,"AfcPractical Recreation Man¬ 
 ual for Schools." 
 
 State Department of Public Instruction *f Virginia., "Play and 
 Athletics for Virginia Public Schools." 
 
 Sfmnle conies tf the "Playground," a monthly magazine, may be 
 
 obtained at the Playground offices, No. 1 Madison Avenue, 
 New York. It should he in every school where the play- 
 life of children is made a feature 
 
 Most rural school playgrounds are too small hut few are well 
 used as they are. The excellent work done by several county 
 superintendents of Pennsylvania in organizing play festivals and 
 school field meets as well as organized play activities at the 
 schools are worthy of wide emulation. 
 
 The Teaching of Hygiene. The text-books used most commonly in 
 the rural schools are not the best. Older texts emphasizing 
 principally the anatomy and physiology of the human body are 
 quite common, but the newer books dealing with how to live 
 healthily and hapwily in this world are making their way. Me 
 need hygiene books especially constructed for rural schools. 
 
 Since each township selects its own text-books in this state, 
 it has been difficult to learn of the actual texts that are 
 generally used, althoughquestions asked teachers assembled in 
 several oounty institutes seem to support the above con¬ 
 
 clusions. 
 
 Teachers should learn to teach hygiene in such a way as to 
 create habits and ideals of healthy living. B$ daily question¬ 
 ing the pupils about the ventilation of their sleeping rooms, 
 about their use of a tooth brush and visits to a dentist, about 
 the drinking of coffee and tea, about bathing and washing, about 
 bathing and washing, about hours of sleep, about their food, 
 and many •ther matters, a teacher may gradually change the 
 health habits, ideals, and standards of a. community. The sug¬ 
 gestions given in Hoag and Terman's book previously mentioned 
 ere helpful. Every case of sickness of the pupils and every 
 case of physical defects may he utilizer) in one way or another 
 

 V 
 
 
 5 • 
 
 
 
 
 
 i 
 
 i -* 
 
 A 
 
 -r 
 
 - rvrr r V :/,«r •• 
 
 j! 
 
 
 
 
 ■ • 
 
 
15- 
 
 without offence in developing right rttitudes toward the health 
 problem and right hr-hits for solving it. J -s suggested before, 
 teachers and county superintendents and supervisors must first 
 be e'uc; ted along health lines. With the present large number 
 of valuable bool's there is no excuse for ignorance along these 
 lines. /■ volume on school health can be read in & few evenings 
 spent as concentratedly as teachers read novels. 
 
 The Hygiene of Instruction, of Methods of Teaching and Management. 
 The poor arrangement of programs of study, the irritating methods 
 of management end discipline, the lack of tact end control, may 
 all be means of lowering the tone, mid consequently the health, 
 the classroom. Just as a well lighted, end well tinted room 
 with beautiful, restful, and suggestive decorations may be a 
 great means toward joy and health, so may the teaoher’s method 
 of teaching and management be a benediction or its opposite. 
 
 Rooms :nd teachers observed seem to require this suggestion. 
 
 In general, we regret the lack ff data and the lack -'f time 
 for the preparation of this study. The school spirit of the 
 rural teachers has a healthy tone, as is evidenced by the appro¬ 
 priation for the expenses of the survey; good work is being done 
 along all health and development lines; Pennsylvania is near 
 the front in this work; and the opportunity before the teachers 
 and statesmen of the state at the present time is very great. 
 
 With further investigation and co-operation for bringing recom¬ 
 mendations to pass we may well hope to lead the nation in this 
 ^rent work. EXHIBIT A 
 
 3/HITARY INSPECTION OP SCHOOLS - SESSION 1912-13 
 
 Sanitary Survey 
 
 No, tf schools inspected 7,375 
 
 N*. of schools unsanitary 6,730 
 
 Np. of schools sanitary ' 645 
 
 30H001 BUILDING NDIOBER 
 
 Jifo. of individual rooms inspected 11,684 
 
 'No. of rooms having sufficient air space 5,®25 
 
 No. of rooms deficient in air space* (fkotn^te:-* on. 6,659 
 
 ft. not given in 16) 
 
 Are rooms clean 9 
 
 Is saw dust or other substance used with a 
 disinfectant before sweeping? 
 
 Has dry dusting been absolutely abandoned? 
 
 Does light enter in front of seated pupils? 
 
 Does light surface equal 20 per cent of 
 floor surface? 
 
 If pencils or ^ens are collected are they re¬ 
 distributed so as to insure each pupil 
 getting Jhis •wn? 
 
 If "Plenum" or other system of artificial vent¬ 
 ilation is used, is it in good working order? 
 
 Are some wfp-dawo oi™-— — ■ ■ ‘ " - J - - 
 
 • • • « • 
 
 YES NO 
 
 11, <129 
 3,476 
 
 389 
 
 8,151 
 
 4,787 
 
 1,399 
 
 6,776 
 
 6 853 
 10 * 131 
 4,793 
 
 5,663 
 
 716 
 
 3,228 
 
 1,368 
 
 n cor 
 
 369 
 

 
 > 
 
 ' ■ ■ • 7 ; *■-•• * v ' “■ 
 
 *5R5SC 
 
 • -VfWsr ^^W***^' 
 
 '^W 
 
 
 
 
 • . 
 
 "SST '-“9*r - 
 
 -.vw« r , 
 
 
- 16 - 
 
 
 Yes 
 
 lie. 
 
 Are some windows always open if the system is 
 
 3/695 
 
 369 
 
 nrt in full operation? 
 
 If no artificial system of ventilation is used. 
 
 5,663 
 
 716 
 
 are some windows always '•'pen from ton or 
 hottorn? 
 
 /■re ventilation hoards used under lover sash? 
 
 1, 2-8 1 ' 
 
 5,943 
 
 Are windows open during recess? 
 
 6,682 
 
 562 
 
 Are yellow or linen colored shades used? 
 
 2,564 
 
 4,594 
 
 If room is heated with stove is stove jacketed? 
 
 3 ,f 51 
 
 3,141 
 
 Is cold air admitted at the stove? 
 
 1,149 
 
 5,255 
 
 Are efforts made to keep air of room moist? 
 
 2,411 
 
 4,7H 
 
 /re dustless crayons used? 
 
 4,474 
 
 2,3*4 
 
 If modern heating device is used, is it a. 
 
 direct heating system? 
 
 1,262 
 
 715 
 
 If indirect heating system is used, do cold 
 
 1,471 
 
 614 
 
 air ducts receive air remote from lava¬ 
 tories and water closets? 
 
 Are adjustable seats used? 
 
 1,535 
 
 5,614 
 
 If seats are not adjustable, are foot-stools 
 
 618 
 
 5,484 
 
 provided for children whose feet will not 
 touch floor? 
 
 Is a well ventilated, clean, dry, cloak room 
 
 2,666 
 
 4,368 
 
 pro videcL? 
 HATLjBj. _ETC._ 
 
 /re the halls clean? 
 
 2,674 
 
 17* 
 
 Are they 'ell lighted? 
 
 2,78 r 
 
 288 
 
 /re they well ventilated? 
 
 2,773 
 
 291 
 
 Has the roller towel been abolished? 
 
 3,049 
 
 1,770 
 
 bo the emit doors onen outward? 
 
 1,554 
 
 3,319 
 
 Are stairs wide and straight? 
 
 1,543 
 
 449 
 
 Are exits free from obstruction? 
 
 4,124 
 
 117 
 
 Are iron fire escapes provided? 
 
 "D/j oy . y-.- j r ji 
 
 263 
 
 2,137 
 
 Is the basement clean and dry? 
 
 1,376 
 
 263 
 
 Is the 'dumbing modern-' 
 
 041 
 
 166 
 
 Is the basement veil ventilate? ' 
 
 VATOR sir;?j : Y 
 
 1/14 
 
 287 
 
 Does the school have its own local water supply? 
 
 1,769 
 
 5,363 
 
 Is it apparently pure? 
 
 5,133 
 
 256 
 
 Is it protecte? 1 rnm surface drainers' 3 
 
 5,400 
 
 889 
 
 Is it free from cesspool, privy, vault or 
 manure drainage? 
 
 6,005 
 
 285 
 
 Is water stored in a covered container? 
 
 2,397 
 
 4,195 
 
 Does container have spigot at bottom? 
 
 2,115 
 
 3,736 
 
 Is the container scalded daily? 
 
 549 
 
 5,421 
 
 Is a fresh supply secured each session? 
 
 5,149 
 
 912 
 
 Is b public water supply used? 
 
 1,255 
 
 5,539 
 
 Are sanitary drinking fountains provided? 
 
 617 
 
 6,«23 
 
 Have common drinking cups been abolished? 
 
 2,6^6 
 
 4,573 
 
 Are individual drinking cups provided? 
 
 3H0TJNLS 
 
 2,111 
 
 4,931 
 
 Are playgrounds adequate in size for number 
 
 6,395 
 
 718 
 
 • f pupils? 
 

 / 
 
 
 
 ■ ••‘r,'-» 
 
 
 rrt‘* -v v*> 
 
 / 
 
 
 • **«; 
 
 >7 
 
- 17 - 
 
 7 re the 7 well drained? 
 
 Is there evidence §f ground pollution? (is 
 urine or feces deposited^on the surface *f 
 the ground.) 
 
 Is garbage nronerly destroyed 9 
 'Are there rccuraulations of manure A r #ther re¬ 
 fuse in vicinity of school grounds 7 
 3M A*E hlSPOSAT 
 
 7 re separate 'ur ivies provided for each sen? 
 
 Are the" in good repair? 
 
 Are the approaches tightly screened 7 
 Are they clean? 
 
 Are 'eep vaults provided? 
 
 Are vaults water tight'’ 
 
 Is suface drainage excluded from nr ivy 
 contents? 
 
 Is lime o r other disinfectant used 9 
 /re vaults or cesspools filled within one 
 foot of the top? 
 
 If modern flush closets are provided, do they 
 discharge into a public sewerage system? 
 
 Are they clean? 
 
 ho they discharge into cesspools? 
 ho they discharge into streams? 
 
 're soil • ices carried through roof? 
 
 EXHIBIT h 
 
 YES 
 
 NO 
 
 6 "63 8 
 
 k/i r\ 
 
 K. .XT 
 
 282 
 
 6,7 73 
 
 6,711 
 
 219 
 
 176 
 
 6,909 
 
 7,056 
 
 112 
 
 5,214 
 
 1,699 
 
 3,398 
 
 5,699 
 
 5,250 
 
 1,797 
 
 3,071 
 
 3,796 
 
 1,771 
 
 4,506 
 
 7,054 
 
 3,742 
 
 2,675 
 
 4,251 
 
 1,169 
 
 4,970 
 
 273 
 
 295 
 
 46* 
 
 62 
 
 12* 
 
 40 5 
 
 164 
 
 393 
 
 321 
 
 245 
 
 DEATHS OP CHILDREN 0 r ' SCHOOL AGP m ^ENNSYLVANI/ , 1912 
 Selected from National Mortality Statistics 
 Principal causes of death in order of frequency for sum of all age 
 
 
 Lower Elementary 
 
 High 3 Grammar 
 
 Total 
 
 
 School Age 
 
 School Age 
 
 School J 
 
 
 
 5—9 
 
 10—19 
 
 5—r 
 
 Tc 
 
 tals for all ages 1 
 
 , 202 
 
 1,614 
 
 2,816 
 
 1. 
 
 Accidents (total) 
 
 568 
 
 749 
 
 1,117 
 
 2. 
 
 Tuberculosis (total) 
 
 189 
 
 895 
 
 1, *84 
 
 r 
 
 ^ • 
 
 Diphtheria 
 
 497 
 
 116 
 
 613 
 
 4. 
 
 "'neumonia ( to tal) 
 
 148 
 
 243 
 
 591 
 
 o . 
 
 Heart Disease, Organic 
 
 1*1 
 
 208 
 
 589 
 
 6. 
 
 Tychoid fever 
 
 77 
 
 254 
 
 ooo 
 
 7. 
 
 Amend icitis 
 
 57 
 
 189 
 
 246 
 
 8. 
 
 Scarlet fever 
 
 152 
 
 42 
 
 194 
 
 9. 
 
 Broncho- neumonia 
 
 109 
 
 48 
 
 157 
 
 10. 
 
 Rheumatism, articular 
 
 55 
 
 93 
 
 148 
 
 11. 
 
 Meningitis (total) 
 
 61 
 
 63 
 
 124 
 
 12. 
 
 Bright ' s disease 
 
 35 
 
 80 
 
 115 
 
 15. 
 
 ^uerneral state 
 
 0 
 
 1*4 
 
 104 
 
 14. 
 
 Endocarditis, acute 
 
 34 
 
 63 
 
 97 
 
 15. 
 
 Nephritis, acute 
 
 42 
 
 53 
 
 95 
 
 16. 
 
 Measles 
 
 68 
 
 24 
 
 92 
 
 17. 
 
 hiarrhea ft Enteritis 
 
 66 
 
 n 
 
 87 
 
 13. 
 
 Diabetes 
 
 15 
 
 49 
 
 64 
 

 
 
 •■■■■-" ••:,•, .... : & ■ - 
 
 i 
 
 ■■ <•• ■■-,.■ • . v - •'••••; ■ ■■ >/ ; . • > 
 
 
 
 
 
 
 
 MA» 
 
 
 
19. 
 
 £ 0 . 
 
 21 . 
 
 £2. 
 
 2-V- 
 
 2£. 
 
 e r >. 
 
 26. 
 
 27. 
 
 28. 
 29. 
 80. 
 
 18 
 
 34 
 
 52 
 
 29 
 
 23 
 
 51 
 
 9 
 
 42 
 
 51 
 
 18 
 
 32 
 
 5* 
 
 0 
 
 48 
 
 48 
 
 i ; 
 
 •50 
 
 47 
 
 29 
 
 15 
 
 44 
 
 22 
 
 22 
 
 44 
 
 22 
 
 19 
 
 41 
 
 20 
 
 15 
 
 35 
 
 10 
 
 20 
 
 30 
 
 10 
 
 14 
 
 24 
 
 10 ' 
 
 “l 
 
 "11 
 
 uuse s 
 
 of death 
 
 of children of 
 
 j sen c 
 
 in to the 
 
 State Jje" nr Oj 
 
 to v 'a 
 
 shington. 
 
 1.1 sii 0 " 3 cue 
 
 Hernia, intestinal Obs. 
 
 Tetanus 
 E-ilensy 
 
 "'eritonitis, simple 
 Suicide 
 
 Hones, diseases oz 
 Stomach diseases, o.t ers 
 S-'inal cord, other dis. 
 
 Cancer (total) 
 
 "'harynx, diseases of 
 Influenza 
 
 Ears, diseases of .. 
 
 (Small *.oxT ’• 
 
 Note:- This table shows tne 
 are according to the diagnoses 
 
 or H-alth and by it forwarde. ^ . . 
 
 fi -i qpsqps v/hich ere most destructive to child li.i-e ^ 
 
 The means of Prevention along the lines of education develo"- 
 inc- bodilv resistence through e: ercise, careiul c.na frequent 
 s-ection and follow-up nor 1 -, looking out jor carriers ^ in¬ 
 fectious diseases such as typnoid an^ cm.--}! hie. is , ane Uo_. o 
 goinr school, home and co inunit^ sanioe/cion, 
 for rural schools that would hel- 
 its urinei">al life problems. 
 
 setool 
 ent 
 
 thirtv 
 
 ,ese as, 
 
 _ are all ' roblems 
 the rural’population to solve 
 
 HAHIBIT C _ 
 
 Thirtv^seven Causes of Heath for the Entire .emulation m 
 " in the Rural Histricts of Pennsylvania and 
 Arranged in order of frequency. Tiie tot. 
 
 the Rural Histricts, 1912, 
 
 cl number of 
 v/ere 54,219 
 
 deaths in 
 
 Accord in <t to Fisher's tables, £S.X>« #f these deaths of country 
 
 Cities are define 
 1, Heart disease 
 
 deaths of 
 
 neonle were reasonably preventable, 
 as municipalities of 10,000 or more population 
 rural districts 'chose vi fch less. 
 
 2 . 
 
 5. 
 
 4. 
 
 5. 
 
 6. 
 
 7. 
 
 8 . 
 
 9. 
 
 10 . 
 
 11 . 
 
 12 . 
 
 15. 
 
 14. 
 
 15. 
 
 16. 
 
 17. 
 
 18. 
 
 •p. 
 
 Ju\- 
 
 , organs. 
 
 accidents 
 
 4.880 
 
 t. cause , 
 
 Diarrhea 0 Enteritis 4,272 
 Tuberculosis 4,249 
 
 Early infancy other di.4,011 
 / -ic-ple:.;y, oerehral herwS-, 566 
 
 Pneumonia 8 
 
 Nenhritis, acute 2 
 
 Cancer 2 
 
 Hr one .co pneumonia. 1 
 
 Stomach’, other dis. 1 
 
 Hiphtheria croup 
 Old age 
 
 Ill defined diseases 
 Bronchitis 
 Maiformetion 
 Typhoid 
 
 .‘rteries, diseases of 
 
 37. EpiLepey 
 
 479 
 
 ',593 
 
 ,504 
 
 ,942 
 
 ,024 
 
 973 
 
 881 
 
 818 
 
 789 
 
 776 
 
 681 
 
 .880 
 
 19. 
 
 20 . 
 21 . 
 22 . 
 
 23. 
 
 24. 
 
 25. 
 
 26. 
 
 27. 
 
 28. 
 29. 
 3 f. 
 
 31. 
 
 32. 
 
 33. 
 54. 
 3 5. 
 ,38. 
 
 Paralysis 
 
 Convulsions 
 
 Influenza 
 
 'Thooping c^ugh 
 
 Hiabetes 
 
 I.leasles 
 
 Hivsr, cirrhosis of 
 Hernia, intestinal ob. 
 Meningitis 
 Angina pectoris 
 Rheumatism of heart 
 ■Paralysis «f insane 
 Spinal cord diseases. 
 Pulmonary congestion 
 ^er-peral sentioemie 
 Scarlet Eever 
 Appendicitis 
 Liver, other dis. «f 
 
 565 
 
 563 
 
 506 
 
 491 
 
 471 
 
 454 
 
 455 
 398 
 A 67 
 328 
 259 
 256 
 
 oth.244 
 235 
 
 207 
 
 201 
 

 'fSfP" - v- • 
 
 ' ! 
 
 
 ' - . - ' • ".: ■■■,, 
 
 
 V, ; . :X-C- 
 
 
 
 '"’>3*505!*’' 
 
 'a- *rv 
 
fearal 
 
 Fr^m 
 
 rr«v a gohfcle inspected ..«« i • 
 
 Sf#, schorl roams inspected* . • . • • • • 
 
 No, nuT)il3 inspected .«•••* *••• 
 
 N^. nupils defective 
 No, punils not defective. 
 
 'A '■ 
 
 Districts 
 
 7,375 
 11,684 
 3*5,372 
 £28,693 
 76 f 679 
 
 EARS 
 
 Pupils having -defective vision. * • • • • 
 
 No. having cJunetivitis simplex. 
 
 No* having iritis *.«••••«•• 
 
 No. having trachoma 
 HEARING 
 
 *NoI nurils having defective hearing « * . 
 BREATHING 
 
 No. pupils having defective breathing ... 
 No. having serious impairment. 
 
 No. having adenoids, (suspeoted) 
 
 TEETH 
 
 No. having defective teeth 
 
 No. having unclean teeth 
 
 No. having decayed teeth •••.•«** 
 
 No. having gums diseased.. 
 
 TONS ILS AND GLARES 
 
 No. having enlarged tonsils.« • 
 
 No. having greatly enlarged tonsils. • • 
 
 No, having acutely inflamed tonsils; ; ; 
 
 No. having enlarger 1 cervical glands. • . 
 
 TUBERCULOSIS 
 
 No. reported as having tuberculosis. » • 
 No. reported-tuberculosis of Lungs . » * 
 Na, reported-tuberculosis nf Glands • • 
 [No. rent,- tuberculosis of Bones & Joints 
 N ERVOUS PISOASES 
 Cllorea 
 [ Euiler sy 
 S HIN DISE ASE 
 
 No. having shin affections . 
 
 Scabies. 
 
 Impetigo contagiosa, . • 
 
 I Pavus. 
 
 Ring Worm.. 
 
 | Nits in hair . 
 
 i Head lice . ..*.. 
 
 |B*dy lice . 
 
 27,686 
 
 91,561 
 
 928 
 
 26,35ft 
 
 192 
 
 367 
 
 76 
 
 88 
 
 260 
 
 1 
 
 58 
 
 3,657 
 
 11 
 
 6 
 
 82,454 
 
 1,031 
 
 27 
 
 18 
 
 8,818 
 
 10,579 
 2 f 117 
 4,454 
 
 119,246 
 
 87,2*2 
 
 1,126 
 19,65^ 
 
 635 
 
 2 & 
 t, 
 
 4,081 
 
 74,69$ 
 
 £ 5 * 11 :?’ 
 
 27,C*$ 
 
 2,9 f$ 
 3,4 0$ 
 
 39,#5$ 
 9 . 06 ^ 
 29.98$ 
 
 28,5G$ 
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 £83. 
 
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 £83 I LC 
 
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DEI ORMITIES 
 
 No. pupils having deformities . 
 
 Hunch bach.4t 
 
 Club foot . -.50 
 
 Curved snine. 59 
 
 AnlijaLosed Joint .. 13 
 
 Hair lip. £9 
 
 Cleft ualate. 95 
 
 Goitre. .. 347 
 
 Miscellaneous . .. . .896 
 
 NUTRITION 
 
 No. pupils noted, subnormal in nutrition 
 No. pupils noted fair in nutrition •11,463 
 No. pupils noted moor in nutrition ' 2,155 
 JU ARAN TINABLE DISEASE 
 
 No. pupils in school that should have been 
 
 Chickenpox.*. 24 
 
 Uhoo^ing-cough. 24 
 
 Measles . ........ 7 
 
 Diphtheria. . 1 
 
 1,589 
 
 13,618 
 
 in quarantine .• 57 
 
 Teacher's Follow-up-Uf*rk—Session 1912-1913 
 Total No. of letters sent parents through teachers fili.OOl 
 
 Total No. *f teachers sending in replies at end of term 7,375 
 
 Total No, *f rupils covered by teachers' replies 132,462 
 
 Total No. of pupils reported treated 30,099 
 
 Total No. of pupils reported improved 29,245 
 
 Total No. of defects reported improved 38,574 
 
 Total No, of ■;uv , 'ils not treate’ 87,220 
 
 Total No. of records containing no ren*rt 15,143 
 
 Eyes 
 
 Reports Concerning 
 
 Eyes .... . 
 
 Hearing. 
 
 Breathing. 
 
 Teeth.. . . . 
 
 Tonsils. 
 
 Enlarged cervical glands 
 
 Tuberoulosis 
 
 lungs.. 
 
 Bones. .. 
 
 Gla nd s . .. 
 
 Joints . 
 
 Defects 
 
 Not 
 
 Improved 
 
 Improved 
 
 7 ,023 
 
 2,405 
 
 1,052 
 
 480 
 
 1,47# 
 
 784 
 
 21,638 
 
 1,778 
 
 5, #38 
 
 3,173 
 
 479 
 
 243 
 
 12 
 
 3 
 
 1 
 
 1 
 
 3 
 
 • 
 
 7 
 
 0 
 
 IN CONCLUSION 
 
 Ue were unable to obtain frtm the State ,Board #f Health the 
 ren«rts of medical and sanitary inspection »f rural schools for the 
 year 1913-14 and s# cannot record the extensions and improvements 
 in this time. The data given ab«ve from the U.S. Mortality Statis¬ 
 tics and from our state reports indicate,however,a great field of 
 opportunity t« help the people of the country to meet through their 
 public sc'vols this great and largely conquerable monster »f pre¬ 
 mature death,infectious and other illness,and lowered vital efficiency. 
 
 December 5,1914. 
 
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