37 M 
 
 H Z4m 
 
A Survey of the Schools by Teachers 
 
 No. 1 
 
 MINIMUM HEALTH 
 AND SANITATION STANDARDS 
 IN SCHOOLS 
 
 By 
 
 LOUIS I. HARRIS, M. D., Dr. P. H. 
 
 Director, Bureau of Preventable Diseases 
 Department of Health 
 City of New York 
 
 WKEfisnr w uofeay 
 
 * m 
 
 1922 
 
 An Address delivered before The Teachers Union 
 of the City of New York 
 
 PUBLISHED BY 
 
 THE TEACHERS UNION OF THE CITY OF NEW YORK 
 Local 5 , American Federation of Teachers 
 
 70 Fifth Avenue, New York 
 
 Price 10 Cents 
 
INTRODUCTION 
 
 I N the month of January, 1921, the Teachers Union of the City of New York began 
 a survey of the public elementary and high schools of the municipality. An appli- 
 cation to the Board of Superintendents for a leave of absence without pay for the 
 President of the Union has been made as a preliminary to undertaking the survey. But 
 the application was refused on the stated grounds that there was no need of a survey 
 of the schools and that the person applying for the leave of absence was not qualified 
 to undertake a survey. 
 
 Inasmuch as the union movement among teachers is characterized by a growing 
 desire on the part of teachers to improve the conditions under which the work of 
 teaching is carried on, the Teachers Union decided to go ahead with its plans. 
 Accordingly, it was decided by the Union that the President should resign his position 
 as teacher in a high school. The resignation was accepted January 3, 1921. 
 
 The letter of resignation dated December 14, 1920, contains this statement quoted 
 here to indicate the scope of the inquiry proposed: “Among the conditions inquired 
 into should be the following: The physical conditions, the conditions relative to ad- 1 
 ministration, the conditions relating to teaching. In addition, I believe it is important ' 
 that studies be made of the quality of our ideals in relation to the prevailing schools 
 of educational thought. In this connection, we should know the source of the moral, 
 the social, the civic and the professional inspiration of our teachers. The study of } 
 these conditions in relation to the product as shown in the output of our schools and in 
 the quality of our citizenship should give us important leads for fundamental changes/’ 
 Those who are familiar with conditions in the field of public education know that 
 the teachers themselves have developed few standards of a professional nature. What- 
 ever standards there are have been set up by those who control. They are modified 
 scarcely at all by those who do the work of teaching. In general this state of affairs 
 has tended to establish among teachers a feeling of indifference to conditions of work. 
 In the City of New York many teachers seem to believe that certain unfavorable con- 
 ditions under which they endeavor to do their work are unavoidable, and make no 
 effort to have them corrected. Doubtless a large number of teachers do not even 
 desire better conditions, because of ignorance of higher standards than now prevail. 
 
 The Teachers Union since its organization in March, 1916, has been associated 
 with the union movement in industry, and has become convinced that the development 
 of standards in education must take a path similar to that followed by the workers. 
 If conditions are to be improved, the effort in that direction must be made by the 
 persons who are in direct contact with the conditions. Democracy in education, as in 
 industry, cannot exist without the organized and democratically controlled effort of 
 the workers. 
 
 Improvement in the conditions under which work is done leads logically to im- 
 provement in the product of work. The Teachers Union has striven to make clear 
 to the teachers the need of professional standards that will aid all those who teach in 
 producing work that has marks of high educational and social value. The Union 
 believes that the first step in the direction of educating the members of our profession 
 to think in terms of standards is to set before teachers such health and sanitation 
 standards as those offered in this publication. The author of the article printed here- 
 with was for several years Director of the Division of Industrial Hygiene of the New 
 York City Department of Health. In that position, and as teacher of Industrial 
 Hygiene in Bellevue Medical School, as well as in his present position in the Depart- 
 ment of Health, Dr. Harris has been able to speak with authority on the subject of * 
 standards of health. # * 
 
 The distribution of this pamphlet among the members of the Teachers Union will 
 be followed by a study of the physical conditions prevailing in the schools covered by , 
 our membership. The facts thus collected will be prepared as a publication of this ^ 
 School Survey series, and will be used for the purpose of arousing the public to the 
 realization of the actual physical environment in which children spend their days in 
 school. A serious effort will be made to carry out a study of the health of teachers 
 along the lines suggested by Dr. Harris. Preliminary inquiries made of our members 
 indicate that it will be possible to obtain the consent of at least one thousand teachers 
 to agree to having exact studies made of their personal health in relation to their 
 work as teachers. 
 
 The Teachers Union expects that the establishment of improved standards of a 
 physical nature in the schools will not be attained until the teachers themselves have 
 increased their interest in the matter of needed changes. Similarly, in the administra- 
 tion and in the teaching standards, which have already been given some attention by 
 our organization, hard work and constant agitation will be necessary to the attain- 
 ment of our aims. 
 
 This pamphlet is offered to the public as a social contribution by teachers to the 
 work of preparing children for life. Other contributions made with the same end in 
 view will follow as rapidly as means and time make possible. 
 
 The Teachers Union of the City of New York. 
 
 HENRY R. LINVILLE, President 
 
MINIMUM HEALTH AND SANITATION STANDARDS IN SCHOOLS* 
 
 LOUIS I. HARRIS, M.D., Dr. P. H. 
 
 Director, Bureau of Preventable Diseases, Department of Health, 
 
 City of New York 
 
 I N this address it is aimed to present an outline of minimum sanitation standards 
 for the protection of school children and teachers. The contributions made 
 by various observers to our knowledge of the sanitary and working condi - 
 
 ( tions in schools and their effects upon the health of the pupils and teachers 
 are very meagre. Much valuable information is available with reference to the 
 health of school children as a result of school medical examinations and special 
 studies. Aside from Terman’s ‘The Teacher’s Health,” there have been no very 
 substantial, scientific or comprehensive contributions on the subject of the health of 
 teachers. The health of the teacher determines not only the quality of his services 
 to the individual and to the community as a whole, but is also of grave concern to 
 every parent as an index of sanitary conditions in the school environment. 
 
 A note of caution should be sounded with respect to certain fallacies that 
 ers, particularly those dealing with the mortality rate from various diseases among 
 underlie the statistical studies which have been made of the health of school teach- 
 those so employed as contrasted with other occupational groups. The reports of 
 the Schlockow Committee and of Dr. L. I. Dublin on this subject do not present 
 typical cross-sections which give a fair basis for judgment as to the degree to 
 which the teaching profession is a hazardous one. These studies present but a 
 fragmentary picture covering a limited period of time, and in the main, a record 
 of those illnesses and diseases exclusively, for which the regulations provide com- 
 pensation or, which, for other special reasons, come under official notice. 
 
 Those who venture to offer definite conclusions with reference to the presence 
 or absence of hazards in the school environment and the number and causes of 
 illness and deaths are prone to make the same serious error that frequently is 
 noted with respect to military statistics. The cases of illness and of disease which 
 are published in military statistics are, by and large, those which cause a relatively 
 marked disability. At the close of the recent war, morbidity and mortality statis- 
 
 I tics were published showing the incidence of disease and of deaths, and their 
 causes, in the army. Since then, however, through various sources — official and 
 unofficial — much additional information has come to light about the many cases 
 of so-called “irritable heart,” of mental disease, as well as of thousands who since 
 the close of the war have come to official notice as the subjects of tuberculosis, 
 or as suffering from the sequelae of poison gases, under-nutrition, severe physical 
 labor, and exposure. These as well as other conditions have been responsible for 
 much illness or disability which did not appear in official records. Those who 
 continued in the trenches despite certain more or less significant illness were also 
 never reported. Likewise, with respect to the statistical studies of teachers. 
 
 The Kind of Study That is Needed 
 
 What is now required is a study that will reveal not only the cases of illness 
 in teachers which come to official notice, but also a large number not officially 
 
 * Address delivered before The Teachers Union, March 17, 1921. 
 
 o 
 
4 
 
 Survey of the Schools by Teachers 
 
 noticed, which have a serious effect upon the physical and mental well-being 
 of teachers, affecting their capacity to teach and the quality of their work. We 
 should know how many of these teachers persist in remaining on active duty 
 in the trenches, so to speak, despite ailments and illnesses which affect them, and 
 who thus really “malinger” or pretend to the possession of health which they do not 
 have. Such studies should cover an adequate span of years and should subdivide 
 the teachers who form the subject of such studies, not only according to sex, but 
 into the various age-groups, so that we may record whether they are subject to a 
 variety of diseases which are directly or indirectly caused by their vocation, and 
 particularly whether such diseases appear in a relatively early age or group. In 
 other words, whether they suffer prematurely from the effects of fatigue, from 
 any specific disease, or from the result of exposure to unsanitary conditions. The 
 cases of illness should be studied and referred back, if possible, so as to learn 1 
 whether there is an association between a particular type of illness or disease or 
 cause of death, and the conditions obtaining in respective schools. 
 
 Such studies should aim to determine how much of the “labor turnover” or the 
 desertions from the ranks of the profession are due to discomfort or ill health 
 induced by the nature of the work. As the result of their experience, industrial 
 hygienists invariably ascribe a certain amount of labor turnover to conditions in 
 industry which have a relation to health and comfort. In such studies, emphasis 
 should not be laid merely upon the number of deaths, or even upon the number of 
 cases of illness from various causes, but special consideration should be given to the 
 question whether the work in a given group or type of teachers is compatible with 
 “keeping fit” so as to enable the teachers to enjoy normal and healthful life. Fur- 
 thermore, such studies should not be rated as complete unless they are based on the 
 most careful clinical observation of a large number of teachers over a considerable 
 period of time, so as to measure more accurately the effect of the work that they are 
 doing upon the general powers of resistance and general well-being, as well as upon 
 the nervous system, the heart, the digestive system, the lungs, and the other parts 
 of the body. Due consideration should of course be given to any personal habits, 
 unusual home conditions, or to a physical condition antecedent to entering the pro- 
 fession, which may have exerted an influence in causing certain clinical conditions 
 that may be observed in the course of such studies. 
 
 In the slow evolution of things, the necessity for the medical examination and 
 supervision of school children has become recognized by civilized nations and by 
 the more progressive communities. We must be sure that school children who are 
 being medically examined for the discovery and correction of physical defects are 
 not in the meanwhile subject to environmental conditions within the school which 
 may in greater or less measure be responsible for the development of such physical 
 defects and disease. Therefore, the sanitary conditions of the school environ- 
 ment and the health of the school teacher who comes in immediate contact with 
 school children are interlocked, and must be most carefully considered together. 
 
 The school teacher who suffers from a communicable disease, such as pul- 
 monary tuberculosis, is a grave menace because of the intimate contact with rela- 
 tively large numbers of children, who, as medical men well know, are most subject 
 to tuberculous infection. Therefore, the sanitary conditions prevailing in schools 
 which may favor the development of tuberculosis or other communicable dis- 
 eases are of very great significance from the standpoint of their influence upon 
 
Minimum Health and Sanitation Standards 
 
 5 
 
 pupil and teacher. Moreover, ill health may have a very serious effect upon the 
 disposition and temperament of school teachers, and may seriously influence their 
 work in molding the character of the pupils under their care. 
 
 Fatigue 
 
 With our gradual advance in medical knowledge has come a better understand- 
 ing of the particular significance of fatigue, not only as the cause of mental 
 strain, of so-called “neurasthenia,” but also as the cause of a direct or indirect 
 reaction through nervous channels upon various organs and glands in the body, 
 
 I the complex actions of which are delicately balanced and correlated. A disturbance 
 of one such organ or gland may radiate to many others, and cause perversions of 
 circulation, and of many of the vital processes of life. We have also come to 
 appreciate the fact that the powers of resistance of the body, which determine 
 how susceptible an individual may be to any one of the communicable diseases, 
 are very seriously affected and undermined by fatigue. Fatigue, therefore, aside 
 from causing certain nervous or mental disorders may play a serious role in 
 influencing the development of a variety of organic diseases, or in predisposing 
 individuals to communicable diseases. 
 
 Fatigue is not only determined by the number of hours of work, or by the 
 number of days of work each week, but depends to a great degree upon the char- 
 acter of such work. It is especially induced by the necessity of concentrating, 
 and taxing the attention, the memory, and general alertness. For example, every- 
 one who has had experience in studying fatigue in industry has given attention 
 to the strain upon the girls engaged in the process of weaving who may have to 
 take care of twelve or even more looms at a time, or upon girls doing similar 
 types of work which require them to attend to from twelve to thirty or forty units 
 of machinery at one time. In like fashion each pupil may justly be regarded as 
 comparable to a unit of machinery, insofar as it taxes and strains the mental and 
 visual faculties of the teacher, and causes a physical effort on the part of the 
 teacher in the course of teaching, disciplining and speaking to a large group. No 
 one, except those who have done public speaking or teaching continuously for pro- 
 longed periods, can appreciate the physical as well as the mental strain which con- 
 stant loud speaking may cause. Fatigue is greatly aggravated by any insanitary 
 
 I condition which may obtain in the school or classroom. Excessive heat, poor 
 ventilation, inadequate lighting, dust in the air — all of these, and many other 
 environmental factors tend to aggravate as well as to induce fatigue. 
 
 In industry it has frequently been possible for experts who study fatigue, to 
 recognize its presence and to estimate its degree by the amount of spoiled work 
 which is produced by those who are suffering from this condition. Unfortunately, 
 this test cannot be applied in dealing with that intangible product of the teachers’ 
 labors — namely, knowledge and character development. It would be of inestim- 
 able value if the “spoiled work” of teachers, as the result of the fatigue from 
 which they may be suffering, could be even approximately estimated. It would 
 be most valuable to know how many children were unfavorably influenced with 
 respect to the acquirements of character and knowledge, or were “spoiled” or 
 marred in the process of their making as the result of fatigue in the teacher. Un- 
 fortunately, it has been found that workers themselves are not always conscious 
 of fatigue, nor are their sensations a reliable guide as to its presence. For these 
 
6 
 
 Survey of the Schools by Teachers 
 
 reasons too much stress cannot be laid upon the importance of having proper and 
 sanitary environment, so that children who spend a considerable part of their 
 growing years in the school environment shall not be unfavorably affected by 
 insanitary conditions — and teachers likewise — and so that conditions of work shall 
 not be productive of fatigue which may cause a marked susceptibility to dis- 
 ease in both pupil and teacher, or be reflected ultimately in the character of the 
 children who come out of our schools. 
 
 Occupational Diseases of Teachers 
 
 While tuberculosis is not a conspicuous hazard in the teaching profession, it 
 must nevertheless be reckoned with as a most important disease, to which teachers 
 are in a fair measure exposed and subject. No adequate scientific work has yet 
 been done under proper medical direction to ascertain to what extent the physical 
 condition of teachers before they enter upon their profession, or the home con- 
 ditions, the school environment, or the exposure to conditions which may favor 
 the development of bronchitis or respiratory infections, as well as personal habits, 
 may each contribute to call into activity a latent tuberculous infection which most 
 adults harbor, and cause an active process to be lighted up. In the study made 
 by Dublin of morbidity and mortality statistics which were available through 
 official sources, he pointed out that only thirty-eight teachers had pulmonary 
 tuberculosis during 1915. It is reasonable to suppose that the thorough and sys- 
 tematic physical examination of our school teachers would have revealed a very 
 considerable amount of tuberculosis that had not previously been recognized or 
 disclosed. Pulmonary tuberculosis, even if there be but thirty-eight cases of it 
 among school teachers, is a much more grave condition in members of this pro- 
 fession who come in such direct and intimate contact with great masses of children 
 than is indicated by its numerical prevalence. Especially because, as already men- 
 tioned, childhood is the age of greatest susceptibility to tuberculosis, the tuber- 
 culous teacher is potentially a distributor of such infection to all of his or her 
 pupils. 
 
 Other Occupational Diseases 
 
 While there is much that is indefinite with reference to the prevalence of 
 specific occupational hazards or diseases among teachers, because of the fallacious 
 methods of inquiry upon which we have heretofore had to depend for our statis- 
 tical knowledge, one may, however, state quite definitely on the basis of statistical 
 evidence that tuberculosis, chronic laryngitis, or “speaker’s voice,” nervous dis- 
 orders which assume a variety of forms, especially so-called “neurasthenia,” diges- 
 tive disorders, respiratory infections (notably acute bronchitis, influenza, pneu- 
 monia and follicular tonsilitis), as well as defective eyesight, may be properly 
 regarded as occupational diseases incident to teaching. 
 
 Neurasthenia and other nervous disorders have already been referred to as 
 being very frequent among school teachers ; — it is fair to assume this prevalence, 
 not only on a statistical basis but also because they have been found to be most 
 markedly prevalent among skilled workers in various other professions and trades. 
 As already briefly indicated, the nervous manifestations may cause reflex dis- 
 turbances as of the digestive organs, or the generative organs in females. Such 
 nervous disorders may be temporary in character, or they may be firmly and per- 
 
Minimum Health and Sanitation Standards 
 
 7 
 
 manently established. Acute infectious diseases would no doubt be found to be 
 relatively frequent, if the health of teachers was studied, not merely by means of 
 the compilation of inadequate statistics, but by continuous medical supervision, 
 and by follow-up to ascertain the causes of absence. The intimate contact of 
 teachers with children, who, as is Well known, are especially susceptible to a 
 variety of acute infectious diseases, makes them likely to contract such diseases. 
 
 Chronic laryngitis has been very frequently found among teachers, as indeed 
 among others who are compelled to use their voice a good deal. This results in 
 hoarseness and very considerable discomfort, and may be followed by a secondary 
 
 ( bronchitis, resulting from extension of the inflammatory conditions affecting the 
 larynx and the pharynx. Laryngitis, and acute or chronic bronchitis, are in a 
 measure capable of being caused as the result of exposure to chalk dust. Dr. 
 George M. Kober in his latest work (Kober & Hanson’s Occupational Diseases) 
 has particularly emphasized the hazard from chalk dust not only with relation to 
 bronchitis, but with reference to the development of pulmonary tuberculosis. In 
 reviewing the prevalence of tuberculosis in teachers which some writers have 
 reported as being comparatively low, he says : “Higher rates for tuberculosis have 
 been reported by Schmidt of Dusseldorf (than death rate of 1.3 males and 1.55 
 per 1000 females in Bavaria), and our American statistics also indicate that school 
 teachers are slightly more liable to tuberculosis than members of the other learn sd 
 professions. 
 
 “This is doubtless due to indoor life, confinement in badly ventilated school 
 rooms and the presence of dust. Diseases of the nervous system and uterine 
 organs are also quite common, and teachers will do well to insist upon proper 
 seats, absolute cleanliness of the school room, fresh air schools, or at least copious 
 ventilation, and susbstitution of wet for dry methods of removing chalk mark- 
 ings.” 
 
 Defective eyesight is very commonly found among school teachers, and while 
 no doubt it is in a measure due to the strain upon the eyes in the course of prepa- 
 ration for their profession, it may also, however, be produced in a very consider- 
 able number of cases by the strain to which sight is subjected in the course of 
 routine work, and particularly by defects of lighting. While there is insufficient 
 evidence to warrant many of the statements which have been made with reference 
 | to the prevalence of certain diseases among teachers, one may nevertheless venture 
 I to assert that thorough and frequent medical examination of many teachers over 
 I an extended period of time, with a scientific method of health-bookkeeping, would 
 | show the existence of numbers of organic defects which have not thus far been 
 recognized or justly appraised. Surely, the glib dismissal of diseases said to be 
 associated with teaching which has sometimes marked the reports of certain 
 studies based on manifestly inadequate statistical evidence, is not scientific and 
 has tended, unintentionally no doubt, to treat these moot points as if they had 
 been settled conclusively and for all time. 
 
 In marshalling statistics one must be cautious in their use and in their selec- 
 tion that they may not consciously or otherwise be pressed into service to bolster 
 up fixed preconceptions. As illustration one might balance against some statistics 
 which have been published to discount the existence of occupational hazards in 
 the teaching profession, the report contained in Bulletin No. 106 of the U. S. 
 Bureau of Census for 1909 in which it is shown that in certain age-periods the 
 
8 
 
 Survey of the Schools by Teachers 
 
 mortality of female teachers from certain infectious diseases is higher than for 
 the general mass of females in industry; and from organic heart diseases the 
 mortality is higher for the ages 25 to 44 years than among the general workers 
 of the same age-groups; also the mortality is higher for a kidney disease in the 
 age-group 35 to 44 years for female teachers than it is for general workers. 
 
 DEATHS OF PERSONS IN OCCUPATIONS 
 
 Teachers, Professors in Deaths 
 Colleges (Females) All Causes 
 
 Per Cent, of All Cases at Specified Ages 
 
 TUBERCULOUS LUNGS 
 
 APOPLEXY AND PARALYSIS 
 
 25 
 
 to 
 
 34 
 
 years . . 
 
 ... 269 
 
 35 
 
 << 
 
 44 
 
 a 
 
 .. . 194 
 
 45 
 
 it 
 
 54 
 
 a 
 
 .. . 167 
 
 55 
 
 a 
 
 64 
 
 it 
 
 ... 130 
 
 
 
 
 
 760 
 
 Teachers 
 
 General 
 
 Workers 
 
 Female 
 
 Workers 
 
 38.7 
 
 31.0 
 
 35.7 
 
 19.1 
 
 23.6 
 
 21.3 
 
 7.8 
 
 14.4 
 
 10.2 
 
 7.7 
 
 7.5 
 
 5.6 
 
 ichers General Female 
 Workers Workers 
 
 1.5 1.2 1.3 
 
 4.1 2.7 4.0 
 
 7.8 5.9 8.4 
 
 6.9 10.1 12.3 
 
 HEART DISEASE PNEUMONIA BRIGHT’S DISEASE 
 
 (All Forms) 
 
 
 
 Teachers 
 
 General 
 
 Workers 
 
 Female 
 
 Workers 
 
 Teachers 
 
 General 
 
 Workers 
 
 Female 
 
 Workers 
 
 Teachers 
 
 General 
 
 Workers 
 
 Female 
 
 Workers 
 
 25 to 34 
 
 years . . 
 
 . . 5.2 
 
 4.8 
 
 6.4 
 
 5.2 
 
 7.4 
 
 5.7 
 
 2.6 
 
 4.0 
 
 4.6 
 
 35 “ 44 
 
 a 
 
 . . 9.3 
 
 7.7 
 
 10.5 
 
 11.9 
 
 9.5 
 
 6.4 
 
 7.2 
 
 6.6 
 
 7.7 
 
 45 “ 54 
 
 a 
 
 . . 8.4 
 
 11.3 
 
 12.7 
 
 7.2 
 
 9.0 
 
 8.0 
 
 9.0 
 
 9.7 
 
 10.0 
 
 55 “ 64 
 
 a 
 
 . . 10.0 
 
 15.4 
 
 15.4 
 
 11.5 
 
 8.3 
 
 9.0 
 
 10.0 
 
 11.7 
 
 11.5 
 
 These tables, although significant, show how inadequate available statis- 
 tics are. 
 
 Ventilation 
 
 It may be stated without fear of contradiction that ventilation is the most 
 important factor in relation to the health of workers. Defects of ventilation are 
 the most important single cause of disease in industry. A statement of all that 
 the term “ventilation” comprises when it is used by an industrial hygienist will 
 make clear why it is of great significance. This holds equally true with reference 
 to the school, because it is proper to consider the school as the industrial estab- 
 lishment in which are engaged thousands who are acquiring knowledge and sub- 
 mitting to character development; it is the business environment in which a con- 
 siderable fraction of the lives of pupils and teachers is spent each year. It is 
 commonly understood that ventilation implies the furnishing of an adequate supply 
 of fresh air to a given room, factory, or other space. The industrial hygienist, 
 however, is not concerned merely that the air which is furnished should be ade- 
 quate in quantity, but also endeavors to have it free from contamination both 
 before and after it enters a room. He desires also that dust, bacteria or the 
 exhalations and emanations of the human body and the gases generated by the 
 burning of gaslights be effectively withdrawn ; that the air be of suitable temper- 
 ature and humidity; that it be kept in motion so as not to stagnate, and that it 
 should not be delivered in such manner as to drive it through a given space or 
 room at a great velocity, thus creating a draft. The air supplied must be dis- 
 tributed to all parts of the room. (This is especially important when mechanical 
 ventilation is depended upon.) Natural ventilation through windows or skylights 
 is by far the best. If ventilation is obtained through natural means, that is, by 
 
Minimum Health and Sanitation Standards 
 
 9 
 
 i 
 
 an adequate supply of windows, or skylights, it obviously implies that lighting 
 will at the same time also be improved. When, because weather conditions are 
 unfavorable, or structural arrangements are old or defective, or when for a 
 variety of other reasons it is inadvisable to depend upon natural ventilation, one 
 must re-enforce or replace it by resort to artificial methods of ventilation which 
 depend upon fans to propel air into a room as well as to exhaust or remove con- 
 taminated air. Frequently, artificial ventilation devices, even though they may 
 have been installed at very great expense and at considerable trouble, have been 
 found to be defective and impracticable in operation. Even when a mechanical 
 system of ventilation is found necessary, it does not justify failure to open win- 
 dows at all times when the weather conditions permit. 
 
 The latter statement is in direct conflict with the views which have been held 
 and enforced with reference to this subject, and as the result of which no one 
 has been permitted to open windows while ventilating devices were in operation. 
 Authority for this new view is, however, to be found in the special report made 
 by the Divisional Committee on Heating and Ventilation of the Committee on 
 Welfare of the Advisory Commission, Council of National Defense. This most 
 important report was prepared by some of the foremost engineering authorities 
 in the country. For the sake of emphasis and to overcome the harmful effects 
 of wrong teaching which have been in force hitherto, it is desirable to repeat that 
 the installation of a mechanical system of ventilation in rooms where the natural 
 agencies for ventilation fail or are found insufficient, does not justify the old 
 theory that the opening of windows in such rooms destroys the effectiveness of 
 mechanical ventilation when the latter is in operation. From a hygienist’s point of 
 view, quoting the exact words of the report above referred to, “a room cannot 
 possibly have too many windows, nor can they be opened too often or too much 
 when the external weather conditions permit.” 
 
 The report of the Divisional Committee on Heating and Ventilation of the 
 Council of National Defense, which has already been referred to as an authori- 
 tative guide, unfortunately does not make adequate provision for the amount of 
 space to be furnished each occupant of a working place. A minimum of 400 cubic 
 feet of air space per person should be insisted upon ; 600 cubic feet per person is 
 the optimum. While it is our business to urge and compel children who cough 
 or sneeze to cover up their mouths and noses with their handkerchiefs, we must 
 nevertheless provide an adequate amount of space for each child in a classroom, 
 so that it will be out of range of the discharges from a sneezing or coughing 
 neighbor ; this is a necessary measure of protection against contact infection. For 
 this purpose a minimum of 20 square feet of floor space is necessary for each 
 child in a classroom. In apportioning the above amount of space, it is not intended 
 that one should include in such computation those areas of a room which are not 
 used for seating purposes ; the aisles, however, may be included in such computa- 
 tion. 
 
 For the purpose of adequate ventilation, rooms should be required to have a 
 sufficient amount of window space so as to allow 21 square feet of window area 
 for every occupant of the room ; such windows, however, should open directly to 
 outdoors. When the area of the window space for each occupant averages less 
 than 21 square feet in a given room, it calls for the installation of a mechanical 
 method of ventilation to supplement natural ventilation. When a mechanical 
 
10 
 
 Survey of the Schools by Teachers 
 
 method of ventilation is necessary, the minimum amount of air space should be 
 not less than 600 cubic feet of air per person per hour. If, for example, youi 
 have a classroom in which there are forty children, and you have only 700 square; 
 feet of window area instead of the optimum 840 square feet, then you have a 
 deficiency of 140 square feet of window area in such room. For each square foot 
 of window area that is lacking 100 cubic feet of air ought to be supplied for each 
 occupant per hour. In other words, the mechanical ventilating device must com- 
 pensate for the deficiency of window area in the room by supplying 140 times 10C 
 cubic feet of air for each of the 40 pupils. While the essentials of this calcula- 
 tion concern only the engineer, they are offered in this connection to show that it 
 is not sufficient merely to have an elaborate ventilating device in the room, but 
 that the amount of air which is delivered must be accurately regulated. To be 
 satisfied merely with the placing of a flag in front of each ventilator and to accept 
 its fluttering as an indication that all is well, as has been the custom in man> 
 schools, is to place reliance on a very poor index of efficiency. Moreover, all 
 locker rooms or wardrobe spaces should be adequately ventilated. 
 
 In this connection, it should be pointed out that the ordinary method of stor- 
 ing clothes is one which is not conducive to safety or good health, unless a proper 
 amount of space exists between the clothing of each individual child, so that there 
 mav be no point of contact, and unless the space in which clothing is stored is 
 well ventilated and well lighted. The sterilizing effect of sunlight not only upor 
 the air of rooms which must be breathed by persons, but also upon the air oi 
 locker spaces must not be overlooked. 
 
 The air must not be discharged with velocity at some point in a room to tht 
 inconvenience of some of its occupants but should be properly distributed through 
 out such room. Children who are seated near the windows in a room when 
 natural ventilation is depended upon, should be guarded by a deflector — an inclinec 
 glass or wooden shield placed across the lower end of such windows, to defied; 
 upward air currents entering the room so that they will not directly strike the 
 children. In a similar fashion children who are seated near radiators or othei 
 heating devices may suffer from the effects of excessive heat. Such radiators 
 should be properly insulated by non-conducting material (asbestos), and the 
 heated air should be deflected upward, or, better still, the radiators or heating 
 units should be so distributed as to be at a distance from children’s seats. i 
 
 In a study made by Dr. S. J. Baker, the Director of the Bureau of Chile 
 Hygiene of the New York Department of Health, it was shown that in the j 
 closed-window room which was ventilated mechanically and kept at a temperature 
 of about 58 degrees F., the rate of absences as the result of respiratory disease 
 was 32 per cent, greater than in the open-window rooms which were naturall) 
 ventilated and kept at the same temperature. The best condition of health witl 
 respect to the prevalence of respiratory diseases is found to obtain in the open- 
 window classes. At comparatively frequent intervals, as at the end of each period 
 all windows should be opened, preferably while the children are for the time 
 being out of the room, or, if they must be kept in the room, while the children are 
 exercising. Frequent changes of air are not only conducive to better health ant > 
 comfort, but make for increased efficiency. 
 
 Where mechanical methods of ventilation are depended upon, a “wet am: 
 dry bulb thermometer” should be supplied in each such room, land the teachers 
 
Minimum Health and Sanitation Standards 
 
 11 
 
 should be made familiar with the reading of such thermometers so that they may 
 estimate the relative humidity which should be at least 20 per cent, for any given 
 temperature. A special chart or table is furnished with each such thermometer 
 which enables the teacher after a very brief experience to make the necessary 
 computation. For the average room, a tempetature of 68 degrees F. is most desir- 
 able from the standpoint of health, 
 s 
 
 Lighting 
 
 While proper lighting has not the importance of ventilation in relation to 
 health, it is nevertheless of considerable significance among pupils and teachers 
 because it prevents eye strain. The latter condition may be responsible for seri- 
 ous suffering or discomfort which may be manifested by headache, irritability, 
 lack of attention, fatigue, and be the cause of distant or so-called “reflex” dis- 
 turbances which may be referred to the stomach or to other parts of the body. 
 Dr. Ralph E. Wager of the Department of Biology, Northern Illinois State Normal 
 School, in his study of the health of teachers calls attention to the marked prev- 
 alence of defects of eyesight among them. There can be little doubt that a defec- 
 tive system of lighting may not only react to make teachers and pupils irritable, 
 ! restless and fatigued, but that it may be responsible for the backwardness of many 
 pupils. It is not sufficient to depend on visual tests to discover such defects of 
 eyesight; it is infinitely better to correct improper lighting. 
 
 Seating arrangements should be of such character that the light falls over the 
 left shoulder, and the arrangements of seats as well as the location of blackboards 
 should be ordered so that they may not be placed at an angle which interferes 
 ! with vision and produces a glare. It can be stated definitely that where natural 
 or artificial lighting is used, the writing surfaces, whether blackboards or desks, 
 should be neither too brilliantly lighted so as to reflect glares nor should there be 
 marked shadows upon them. When artificial lights are employed, care must be 
 taken that they should not flicker. Those who are in the habit of reading news- 
 papers or books in the subways can testify to the blinding effects of flickering 
 lights, and they will readily understand how this condition may cause serious eye- 
 strain. 
 
 In connection with adequate lighting, it is well to bear in mind the three 
 requirements which are always insisted upon by leading engineers; namely, suf- 
 ficiency, continuity of light, and diffusion. The sufficiency of light depends upon 
 having an adequate window area. In order that there may be continuity, it is not 
 only necessary to have a large enough window area for use on comparatively 
 dark days, but there must be provided also one or two things — first a way of 
 reducing light when it is excessively bright, and second, a way of increasing or 
 supplementing it when the days are dark as at the close of day in the winter sea- 
 son or on cloudy days. Lighting engineers emphasize the necessity of having 
 rooms painted in light color, especially the ceilings and the upper portions of wall 
 so that light will not be absorbed by dark surfaces, but be reflected and diffused 
 throughout a room. The lower parts of walls should be painted dark to give 
 relief to the eye. The diffusion of light calls also for the proper placing or dis- 
 tribution of widows. 
 
 If the requirements which were specified with reference to the area of win- 
 dow space per person under the head of ventilation are complied with, the light- 
 
12 
 
 Survey of the Schools by Teachers 
 
 ing requirements will at the same time be well met. Adequate natural lighting 
 like natural ventilation is the best. However, we must be careful to prevent the 
 glare of sunshine. In such cases, window shades, especially those which can be 
 raised from below upward, are essential. Windows that have a northern exposure 
 are best for the purpose of lighting. Those that have a southern exposure permit 
 an excessive amount of sunshine to enter during the middle of the day in par- 
 ticular, so that a heavy shade may have to be pulled down to cover the entire win- 
 dow area, thus necessitating the use of artificial lighting during the early part of 
 the day. 
 
 When sunlight enters through the upper part of the window, it may be ^ 
 modified and made agreeable by having translucent window glass put into the I 
 upper sash, or by using light, translucent shades. The light entering through! 
 the upper part of the window diffuses over the widest area in the room. For this | 
 reason it is desirable, to have windows reach to as near the ceiling as possible. 
 The opaque or dark window shade is undesirable. Windows must be kept clean 
 or they will prevent the entrance of an adequate amount of light even though the 
 total area of window space is sufficient. 
 
 If the windows look out upon a more or less confined space, and the light is 
 intercepted or reduced by neighboring buildings much can be done to improve the 
 fighting of such rooms by using what is known as prismatic glass. Prismatic glass 
 is supplied in the form of corrugated glass, or has little prism-like projections 
 which catch the light from any patch of sky which such window may face, and 
 reflect or bend the light, and direct it into the room. While clean windows are 
 always a most important essential for adequate lighting, they are of the greatest 
 importance where prismatic or translucent glass is employed, because in these the 
 light is already to a certain degree modified. 
 
 When artificial lights are employed, they must be properly distributed so as 
 to give light to all parts of the room ; they must be of adequate candle power, and 
 the glare from such light which may fall upon polished desk-tops or other polished 
 surfaces must be eliminated so far as possible by the use of dull paints and by the 
 proper shielding or shading of the light. The lamps that are supplied must be kept 
 clean or a great deal of the lighting power is lost. The use of ground glass electric 
 bulbs or of ground glass globes has found great favor and is very desirable be- 
 cause it prevents glare. Reflectors are extremely valuable in improving and dis- 
 tributing the light thrown by lamps, but they are utterly useless if they are per- - 
 mitted to become unclean. It should also be remembered that a lamp which may 
 give adequate candle power at the beginning becomes worn out with use, and the 
 light therefore grows dimmer. 
 
 If artificial light must be employed in a class room, it is advisable not to de- 
 pend on a single light or a cluster of lights placed in the center of the ceiling, but 
 if possible such lights or clusters should be distributed about the walls or ceiling so 
 as to light up equally well all parts of the room. Any system of artificial lighting 
 which permits marked shadows to be thrown upon any part of the working space 
 or particularly upon the desk, is objectionable and indicates that an improper 
 system is employed. When artificial lighting is employed in class rooms, the 
 optimum amount of light for ordinary use should be four foot-candles. A foot- 
 candle is the common unit of illumination, equal approximately to one watt, and is 
 the amount of lighting effect produced upon an object by a standard candle held 
 
Minimum Health and Sanitation Standards 
 
 13 
 
 at a distance of one foot; roughly, one can estimate whether the four foot-candles 
 which ought ordinarily to be supplied for office work have been furnished, by the 
 following very simple mathematical test: The candle-power furnished by a lamp 
 or cluster of lamps is made the numerator; the denominator is the square of the 
 distance of such lamp or cluster of lamps, from the writing surface. For example, 
 if a single lamp, or if a cluster of lamps in the center of the room, gives a light 
 of 200 candle-power, then 200 is the numerator ; if the distance from the writing 
 surface of a pupils’ desk is the source of light is 10 feet then the square of the 
 distance is 100 feet, and the denominator is therefor 100. We then have a lighting 
 
 ( power of 200/100 which equals 2 candle power; in other words, we have only half 
 the optimum illumination. The minimum which should be allowed for close appli- 
 cation is 3 foot candles ; therefore, in the problem cited, the boy who sits 10 feet 
 from a 200 foot candle light is receiving only one half of the optimum or two- 
 thirds of the minimum lighting required. 
 
 Drinking Water and Drinking Fountains 
 
 All the standards that have been previously outlined have been in agreement 
 with those which are laid down by authorities in the field of industrial hygiene 
 for offices and similar work places. Continuing to apply such standards, it ought 
 to be emphasized that drinking water ought to be readily accessible on the various 
 floors of school buildings so that pupils and teachers may not have to lose time in 
 going a considerable distance to slake their thirst. It is the general experience 
 that where drinking water is not readily accessible, there is a tendency to repress 
 the desire for water. The importance of drinking water in adequate amount from 
 the health standpoint, as well as for the sake of comfort, need not be argued at 
 this date. Nor need one dwell upon the dangers which lurk in the use of common 
 drinking cups. 
 
 The placing of drinking fountains in sufficient number so as to be readily 
 accessible, is the best means of eliminating the use of the common cup. The latter 
 is always to be found where the ordinary faucet is used to control the flow of water. 
 The drinking fountain must, however, conform to a modern design, or it may give 
 a false sense of security with respect to the transmission of disease. Such fountain 
 
 I K must deliver a column of water that rises to a height of several inches. It should 
 [be furnished with a metal ring which prevents bringing the lips in close contact 
 I with the spout of the fountain. The column of water should not, however, be 
 ’a vertical one, because it has been found by experience, that disease germs 
 which may be on the lips of a person who uses the fountain, may remain 
 supported at the top of the column of water for a very considerable period of time 
 without being discharged into the drain. For this reason, the only proper type of 
 drinking fountain is one which delivers an inclined column of water rising to a 
 height of several inches, the inclination being about 15 degrees, so that any germs 
 which may be caught in such a column of water are not kept dancing at the top, 
 as is the case with the vertical water spout, but fall over into the drain promptly. 
 
 Sanitation of the Toilet 
 
 Toilets should be readily accessible. A great deal of unnecessary loss of time 
 results when toilets are housed in a single unit at a considerable distance from the 
 classrooms or offices. Moreover, constipation which is of such frequent occur- 
 
14 
 
 Survey of the Schools by Teachers 
 
 ence among pupils, and among teachers whose life is a sedentary one, is er( 
 couraged when the toilets are at a considerable distance. This is the common 
 experience with large groups of people in industry and undoubtedly applies to th 
 school population. 
 
 It is needless to say that the sanitary standards in the construction and equif 
 ment of toilets should conform to those laid down for industry, that is, there shoul 
 be a sufficient number of toilets for the school population; they should be so cor 
 structed that the ventilation, lighting and heating conform to the standards alread 
 laid down ; they should insure privacy, for it has generally been found that whei 
 there is no privacy, there is a tendency towards demoralization through the for< ■ 
 of bad example and through the operation of “crowd” psychology. The m; m 
 terial entering into the construction of the toilets should be impervious, an 
 non-corrosive, and the construction should allow for proper drainage so that thei 
 may be no stagnation or accumulation and exposure of excrement. The windov 
 and doors of the toilets should be particularly shielded during the spring an 
 summer time by the use of screens to prevent the entrance of flies. 
 
 It should be remembered that while one hundred and eleven typhoid carriers ai 
 known in the City of New York, it has been estimated that from 1 to 5 per cent. ( 
 those who have had typhoid fever remain typhoid carriers, discharging typho 
 bacilli in their excrement for many years or for the rest of their lives. In ti 
 City of New York, we have had over twenty thousand recognized cases of typho 
 fever which were reported to the Department of Health in the last ten year 
 It will be seen at a glance that there must be many more typhoid carriers, eve 
 if we limit ourselves to the cases which occurred in the last ten years, than a 
 known to the Health Department. This may include many school teachers « 
 pupils who recover or who may be healthy carriers. The entrance of flies whi< 
 have access to excrement that is not promptly and effectively washed away < 
 drained, is therefore a possible source of danger. The trough urinal or receptac 
 in toilets, or the so-called school sinks are a source of danger. Water-flush* 
 and properly sewer-connected drainage for all toilet fixtures, together wii 
 screens at windows and doors, are very essential to prevent the possible spread < 
 typhoid fever, and of other intestinal diseases through the medium of flies. 
 
 Washing Facilities in Toilets 
 
 The washing facilities in toilets should be adequate. Typhoid carriers a 
 safe to others only to the degree in which they exercise care promptly and the 
 oughly to wash their hands. Therefore, washing facilities should be available 
 toilets or near toilets, and also in other parts of the building so as to be read 
 accessible. A variety of communicable diseases are no doubt transmitted as t 
 result of infection of the hands through contact with the nose and mouth, as w< 
 as through possible soiling with human excrement. 
 
 The supply of washing facilities, and the installation of hot water regulat 
 so as to be of proper temperature, is extremely important from the standpoint 
 health to the individual pupil or teacher, and to those with whom they may coi 
 in contact. The supply of soap and towels in suitable quantity is also extrem* 
 important. Measures have been devised which permit one to provide these up 
 an economical and practical basis. Special paper towels, as well as propet 
 
Minimum Health and Sanitation Standards 
 
 15 
 
 secured cloth towels, are available on the market. It is more economical to prevent 
 disease by supplying proper washing facilities as well as to inculcate proper per- 
 sonal habits in pupils, than it is to save money by omitting such facilities and 
 ixtures. 
 
 General Cleanliness 
 
 Reference has already been made to the economy which results from keeping 
 vindows and lighting fixtures clean. The general cleanliness of floors and all 
 iurniture hardly needs to be alluded to in the light of modern knowledge. It is 
 mportant that dry dusting and dry sweeping be eliminated from all schools, no 
 matter at what hour performed, but especially before the opening of school or at 
 iny time during the school day. Dry dusting and sweeping tends only to scatter 
 lust, and is not effective for its collection and disposal. Mopping of the floors 
 vith oil cloths or with damp cloths or so-called “settlers/ ” like oil particles or wet 
 sawdust, is essential, and this should be done when the school has been completely 
 emptied of pupils and teachers. In this connection, reference should be made to 
 he chalk dust which is set free in class rooms or which results from the cleaning 
 )f erasers. This should be prevented so far as possible by the use of moist cloths 
 or erasing chalk marks. While this may involve loss of time, it is, however, 
 )rofitable in the long run. Pupils should never be asked to clean blackboard erasers! 
 
 Rest Room and Lunch Room 
 
 In modern industry, it has been found not only desirable but necessary and 
 ‘conomical, to provide a lunch room where those who are unable for a variety of 
 •easons to secure luncheon at their homes or in restaurants, may find suitable and 
 >anitary quarters to be used as lunch rooms. WLile this is not so important in 
 :he school as it is in certain branches of industry, nevertheless, in the interest of 
 ?ood housekeeping and comfort, it is desirable so far as possible to have places 
 which are available for use as lunch rooms for pupils and teachers. While a 
 properly fitted up lunch room which has come to be recognized as an essential in 
 velfare work for those employed in industry, may be difficult to obtain in the 
 schools, there can be no question whatever that a rest room suitably fitted up to 
 >ermit pupils and teachers, who may be temporarily indisposed or ill, to rest, is 
 lecessary as well as desirable. Many absences which formerly occurred in in- 
 lustry because adequate facilities for rest or for emergency medical and nursing 
 •elief were lacking, have now been eliminated in industrial establishments which 
 lave regard for the health of employees. This has been done by the installation 
 )f rest rooms where nursing care or quiet can be obtained and where indispositions 
 ire promptly ministered to with the least degree of suffering to those so affected 
 ind with the ultimate prevention of more serious developments. To use the ver- 
 nacular, rest rooms have been found to be a “paying proposition/’ 
 
 Unfortunately, it is not possible in the brief compass of an address of this 
 character, to dwell upon the necessity for maintaining proper health in pupils and 
 eachers by the observation of rules of personal hygiene which are extremely im- 
 portant, and which, if violated, tend to weaken resistance or favor the development 
 >f disease. Much could be said about the value of an adequate and proper diet, 
 aulty habits of eating, as well as the use and abuse of exercise, the need for rest 
 periods, the value of adequate sleep, the avoidance of exposure to excessive heat and 
 
 I- 
 
16 
 
 Survey of the Schools by Teachers 
 
 cold at various seasons of the year, and the relation of proper methods of dre 
 to such conditions. Attention to these details is required in the school, as w 
 outside of the school. The health aspects of recreation and many other t 
 which are directly related to personal health, might be profitably dwelt upon 
 this address was not intended to emphasize these things. 
 
 By way of conclusion, it is desirable to refer again to the necessity for 
 quate medical supervision and study of teachers, with a view to ascertaining 
 physical condition and fitness at the time of their entrance into the profession, 
 the casualties, and damages to health which may be recorded at various s 
 of their career in the profession, with a view to determining more accurately 
 has been done in the admittedly limited studies which have been made hereto 
 There can be no doubt of the scientific value of studies which concern thems 
 not only with the results of medical examinations made at the time of ent 
 into the profession and periodically repeated examinations thereafter, but also 
 careful sickness reports and follow-up, and medical examinations to recor 
 character, duration and the ultimate effects of all illnesses whether deemed triv : 
 important, conducted over a considerable period of time. In this way alone, 
 be possible to obtain knowledge of scientific value and importance in safegua^ 
 the health of teachers, and protecting pupils from the physical and mental e 
 of sickness, to which teachers may be subject. 
 
 BIBLIOGRAPHY 
 
 Physical Disability of New York City School Teachers — Louis I. Dublin, Ph.D 
 
 Ad-interim Report of an Investigation of the Absences of New York School Tea 
 During the School Year 1913-1914 — Dr. Oswald Schlockow. 
 
 Health of the School Teacher — Dr. Ralph E. Wager (published in the Journ 
 Industrial Hygiene, September, 1920). 
 
 Report of Commission on Welfare of Teachers — T. D. Wood, New York State Tea 
 Association, 1916. 
 
 The Teacher’s Health — L. Terman. 
 
 Diseases of Occupation and Vocational Hygiene — Kober & Hanson. 
 
 Classroom Ventilation and Respiratory Diseases Among School Children — S. Jose 
 Baker, M.D., Department of Health, New York. 
 
 Report of Divisional Committee “Code of Lighting” of the Committee on 
 Advisory Commission, Council of National Defense — Bulletin No. 3 of W 
 Work Series, Government Printing Office. 
 
 Report of the Divisional Committee on Heating and Ventilation of the Commit 
 Labor, Advisory Council of National Defense — Bulletin No. 4 of Welfare 
 Series, Government Printing Office. 
 
 Tentative Syllabus on Hygiene for Elementary Schools — Approved by the Boa 
 Superintendents, Department of Education, New York, September, 1916.