Part 19

Ringworm is a kind of tinea, and it is caused by various mould fungi. Tinea Tonsurans is ringworm of the scalp; Tinea Circinata is ringworm of the body; Barber's Itch is another form; there is also a ringworm of the finger-nails; and Pityriasis Versicolor is still another form. All are contagious, and some are difficult to cure because the parasite gets down between the skin and the hair-follicles and an antiseptic can not reach it. Children affected with these diseases should be kept away from school until they have been cured.

The presence of lice and of the Acarus Scabiei can bring about acute and severe skin eruptions. The Acarus Scabiei causes itch, but fortunately it is rare in America. These parasites go from person to person, hence a child having either should be kept from school until he is clean. A thorough washing will remove lice if they have not yet inflamed the skin, but itch requires a more vigorous {199} treatment. The desks of such patients should be disinfected and their clothing should be baked. They will probably be reinfected at home if the treatment is not applied to other members of the family.

Contagious Impetigo, or porrigo, as it was formerly called, is a skin disease common among children, and it may affect adults. It appears to be of parasitic origin, but the specific organism that causes it has not been isolated. The lesions in this disease are commonly discrete--separate one from another--but they may be crowded together. They are vesico-pustular and they are sunken at the top in the typical form. If they are not broken by scratching, they dry into a yellowish crust. The disease affects only the skin, but as it is contagious a child affected with it should be kept from school until cured. The desk and articles used by the child should be disinfected, and his books are to be burned.

Whooping-cough is very infectious, and, contrary to the popular opinion, it is frequently a fatal disease. There is a period of incubation for from seven to ten days, then a catarrhal stage follows in which the child has the symptoms of an ordinary "cold." In about another week the dry cough becomes paroxysmal with the characteristic "whoop" when the air is drawn in after the fit of coughing. When there is an epidemic of whooping-cough, children with "colds" should be sent home from school. The objects used by a child that has whooping-cough should be disinfected, and its books and papers are to be burnt.

Mumps can be a serious and a very painful disease and it is infectious to a marked degree. The specific organism is not known. Boys are more liable to this disease than girls are, and recurrence is rare. After a period of incubation, which lasts from two to three weeks, there is fever, pain under one ear, and the parotid gland swells. The disease is commonly mild, but it may affect a child seriously. The patient is to be quarantined, what it has touched should be disinfected, and its books are to be burnt.

There are a number of infectious eye diseases that occur among school-children. Acute Contagious Conjunctivitis, {200} or "pink eye," is one of the most important. One form of acute Contagious Conjunctivitis is caused by the Koch-Weeks Bacillus; it is "pink eye," properly so called, and it is very infectious. Objects handled by the patient can infect others and spread the disease. The attack is severe, but the prognosis for full recovery is good. The child should be strictly quarantined until all secretion from the eyes has ceased, and whatever he has touched is to be carefully disinfected.

Another form of Acute Infectious Conjunctivitis, less contagious than that caused by the Koch-Weeks bacillus, is brought about by the introduction into the eye of the bacteria that give rise to pneumonia. Commonly the pneumonia bacteria do not cause conjunctivitis unless the patient is susceptible in a special manner. As it is difficult to differentiate this second form from the first, the same precaution should be used.

Trachoma, called also granular conjunctivitis, Egyptian ophthalmia, and military ophthalmia, is a very serious inflammatory disease of the external eye which has of late years become prevalent in American cities, whither it has been brought by immigrants from eastern and southeastern Europe. Persons that have this disease on landing in the United States are deported, but despite this precaution it has crept in and is now endemic. It is contagious, and when well established it is extremely difficult to cure. If untreated it lasts for years and it may destroy the cornea and consequently the sight. A trachomatous child should be kept from school until it has been cured, and that cure will take a very long time.

The Gonococcus can be carried into the eye by handling objects like soap, towels, wash-basins, which have been used by persons afflicted with gonorrhoea. The infection of the eye is very severe and dangerous, and the usual quarantine is to be observed. The ophthalmia of the new-born is gonorrhoeal.

The Diphtheria Bacillus also may get into the eye, and set up a primary infection there. A membranous conjunctivitis, too, is at times induced by pus organisms. {201} Xerosis Epithelialis, tuberculosis, leprosy, and syphilis may affect the eye primarily, and additional forms of eye-diseases are found that are infectious. The general rule, then, is that children with any inflammation of the eyes are to be kept out of school until a physician pronounces them harmless.

AUSTIN ÓMALLEY.

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XVI

SCHOOL HYGIENE

Priests have to put up buildings for parochial schools, colleges, seminaries, orphan asylums, convents, and the like, but in such work sanitation is commonly given only a passing thought in connection with sewer-traps and these are left to the wisdom of a plumber. The physical welfare of youth is almost as important as its mental training, and there are many factors beside sewer-traps involved in the effort to sustain it.

If there is freedom of choice as regards the site of a schoolhouse or similar building, the top of a small elevation is to be selected. Such a position affords the best natural drainage, removes dampness, avoids inundations, gives full sunlight and the purer air. The top of a high hill may be too exposed to the wind.

Next to the top of a knoll, the southerly slope of a hill is to be chosen. The building should not be overshadowed by a hill, especially on the western side. Trees are not to be planted close to a building in which children live, and ivy and similar plants should not be permitted to cover the walls.

If a building is set in a hollow it will be surrounded with chill air and mists in the cold seasons, even if a costly drainage system keeps the cellar and basement dry.

A gravelly or sandy soil beneath a building is the best, provided this soil is not already saturated with organic matter, or is not close above a dense layer of clay or rock. Clay, marl, peat, and made soils should be avoided if possible, because they are full of organic matter; they are cold, and they infect the ground air. Rock does not make a good building site--its seams carry water.

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The subsoil should be drained four or six feet below the cellar floor, and this floor is to be laid in concrete and cement. At the level of the ground there should be a course of hollow vitrified brick to exclude dampness and to give ventilation.

Limestone walls conduct more heat in and out than an equal thickness of glass, bricks, plastering, and wainscoting. The porosity of the building material determines the interchange of the air through the walls, and it affects the temperature of the rooms. If there is water in the pores of the walls heat is conducted rapidly, but air is not permitted to pass. Brick as a building material has many disadvantages, but on the whole it is best for schools, and it resists fire better than most stones. The harder the brick the better it is--vitrified brick is the best. Hard-pressed brick of a light colour makes an excellent outer wall-surface.

It is very doubtful that sewer gas escaping into a house will directly carry the micro-organisms of diseases like typhoid and diphtheria, but such gas is poisonous, depressant, and it renders the inmates of a house liable to disease; lessens their power of resistance. The typhoid bacillus and other bacteria can, of course, be carried into a cellar by the seeping in of drainage water. Infants kept in the upper story of a house in hot weather are more liable to intestinal diseases than are those that live on the lower floors, but here the weakening agent is heat. Tuberculosis, scrofula, rheumatism, neuralgias, bronchial, and kidney affections are made worse in damp houses.

The chief defects in plumbing and drainage are the following: (1) Earthen pipe drains become broken or their joints leak, and they saturate the ground under a house with sewage. (2) Tree roots break and clog drain pipes. (3) The pipes sometimes have not fall enough. (4) Drains without running traps admit sewer gas. (5) Rats burrow along a drain pipe from the sewer into the house and admit sewer gas. (6) When the soil pipe from a water-closet is exposed in cold weather it may freeze up or be clogged by urinary deposits. (7) Rats gnaw through lead pipes and joints. (8) Two or more closets or sinks with unventilated {204} traps on the same pipe will siphon back sewage. (9) Overflow pipes sometimes have no traps and they let in gas. (10) Ash pits near a house carry moisture to walls, (11) Cesspools leak through the soil.

In planning a school-building the classrooms and the study-halls are the first things to be considered. The classrooms should be oblong, with the aisles running lengthwise. Each child should have at the least 15 square feet of floor space and 200 cubic feet of air space. A room 30 by 25 feet with a ceiling 13 feet from the floor will serve for 48 pupils and no more. This is the best size for a room when blackboards and maps are used in teaching, because a larger room sets the children in the back seats too far away to see without eye-strain.

Dormitories should have at the least 300 cubic feet of air space for each child, and great care is to be taken in the ventilation. Children about 10 years of age require 11 hours of sleep; under 13 years, 10-1/2 hours; under 15 years, 10 hours; under 17 years, 9-1/2 hours; under 19 years, 9 hours. Do not make children get out of bed before seven o'clock in the morning; do not let them study before breakfast, and do not force them to work after half-past eight or nine o'clock at night until they are at the least 17 years of age. The hours for work should be:

Ages Hours of work a week

From 5 to 6 6 6 to 7 9 7 to 8 12 8 to 10 15 10 to 12 20 12 to 14 25 14 to 15 30 15 to 16 35 16 to 17 40 17 to 18 45 18 to 19 50

Work given for punishment must be included in these hours. No one, even an adult, should study for more than two hours at a time without an intermission for a few {205} minutes. In a boarding-school no one under any pretext, even on rainy days, should be permitted to study during recreation hours, and the deprivation of recreation to make up lessons is a relic of barbarism. If a teacher can not get class work done except by shutting up children during recreation hours, remove the teacher or expel the pupil.

The amount of glazed window surface admitting light to a classroom or study-hall should be from one-sixth to one-fourth the floor space of the room, and this must be increased if the light is obstructed by neighbouring houses or trees. The light is to be admitted on the left side of the pupils,--all other windows should be counted as ventilators only. Windows facing the children or the teacher are to be avoided. In rooms fourteen feet high a desk twenty-four feet from a window is insufficiently lighted. The larger the panes of glass the better, and the external appearance of windows is to be sacrificed to good lighting. If screens are used to protect the glass from stone-throwing, allowance is to be made for the light the screens cut off.

If a room can not have enough light from the left side alone, put the additional windows on the right so that their lower sills will be eight feet from the floor; and be careful in this case that the light from the right is not brighter than that from the left.

Windows should have as little space as possible between them to avoid alternate bands of shadow and light. Set them up as near the ceiling as possible, since the higher they are the better the illumination; and they should not be arched at the top. The lower window sills may be about four feet from the floor. When window shades are used to cut off direct sunlight, they should be somewhat darker in colour than the walls.

If artificial light is used in boarding-schools in the study-halls, the best light is one that is as near in colour as possible to the white light of the sun, and ample, but not glaring. It should be steady, and it should not give out great heat nor injurious products of combustion. Hence the electric light is the best; after that, gas through Welsbach {206} or Siemens burners. Well refined kerosene oil gives a good light, but it is always dangerous. Acetylene gas is now used in a safe apparatus, and it also is an excellent light.

No colour that absorbs light should be used on the walls. Pale greenish gray, nearly white, is the most satisfactory colour. There should be no wall paper, curtains, or hangings of any kind in a school or college building. The wall decorations should be as plain as possible, with no roughened places to catch dust.

Stairways are to be well lighted; they should be at the least five feet wide, and have landings half-way between each story. Diagonal or spiral stairways are dangerous. Steps with six-inch risers and eleven-inch treads are the easiest for children, but six-and-a-half-inch risers may be used in high schools and colleges.

Carbonic acid in the air of a classroom is an index of impurity. External air has about three parts of carbonic acid in 10,000 parts of air, and above seven parts in 10,000 is injurious. Each person exhales about fourteen cubic feet of carbonic acid gas in an hour. There is no easy method of determining the quantity of carbonic acid gas present in a room, and we must therefore arrange the ventilation so that about 3000 cubic feet of fresh air an hour will be supplied to each person in the house.

Beside carbonic acid there are other impurities in house air, as dust, micro-organisms of disease, exhalations from bodies, sewer gas, and the like, which accumulate and do injury when the ventilation is defective.

If every person in a house has 1000 cubic feet of air space, natural ventilation will suffice ordinarily, but artificial ventilation is needed in schoolrooms and dormitories. The subject of ventilation can not be satisfactorily discussed in a short article, and those that are interested in school building should leave the matter to a competent architect, or study books and articles like J. S. Billings' _Ventilation and Heating_, Pettenkofer's _Ueber Luft in den Schulen_, and Kober's article on House Sanitation in the _Reference Handbook of the Medical Sciences_.

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The proper heating of a schoolroom is a matter so generally understood that there is no need for special remark here, except this, that provision for proper humidity in the heated air is commonly neglected.

Cheap water-closets do not save money--they get out of order too easily. The pan, valve, and plunger hoppers are not to be tolerated. The only kind to use are short-hopper closets with a trap that opens into the soil-pipe above the floor. These may have valve-lifters attached to the seats, because children forget to flush the hoppers. The ventilation of the water-closets should be separate from that of the main building. In country places where vaults are used, there should be a supply of dry loam kept, and enough of this to cover the fresh contents should be thrown into the vaults every evening.

Children are seemingly always thirsty, and they should be allowed to have all the drinking water they want if the source is free from typhoid germs and infection by organic matter. Common cups are an abomination, and a prolific cause of contagious diseases. Each child should have its own cup.

The rules for desks and seats for children are these:

1. The height of the seat should be about two-sevenths of that of the body.

2. The width of the seat should be about one-fifth of the length of the body, or three-fourths the length of the thigh. Do not keep unfortunate little children's feet dangling all through their school years to save a few pennies on school furniture.

3. The seat should slope downward a little toward the back, be slightly concave, and have rounded edges in front.

4. There must be a back-rest.

5. The child, when sitting erect, should be able to place both forearms on the desk without raising or lowering the shoulders. This is a very important rule.

6. The seat must be correctly placed as regards the distance of its front edge from the corresponding edge of the desk.

7. The desk slope should be 15 degrees.

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Badly constructed desks cause eye-strain and marked distortions of the spine. Desks should be adjustable in height, especially for growing children. School-children grow most rapidly between the ages of twelve and sixteen years--nearly two inches a year--and the desks and seats should be adjusted twice a year at the least. If a child is moved to another desk an adjustment is to be made at once.

To counteract the bad effect of long sitting, even at properly adjusted desks, children should be frequently sent to blackboards, and at regular intervals a few minutes are to be given to "setting up" exercises.

Great attention should be paid to the eyesight of children. Those that complain of headache should have their eyes examined. The lines in school books should be not more than four inches in length, and they are to be printed in clear, well-leaded type. Slates are dirty and unsanitary: let the children write on paper that has a dull finish.

Teachers should prevent lounging positions at desks, especially stooping. They are not, however, to try to make children under fifteen years of age sit still. The youngsters can not remain immovable, and the effort to make them do so is irritating to no purpose.

Nervous children need outdoor exercise more than anything else. When nervousness takes the form of religious scrupulosity in school-children and novices do not immediately apply a moral theology to them--call in a physician that has common-sense, because there is a nervous scrupulosity which is much more frequently met with than the purely spiritual form. Aridity in prayer, a loss of sensible devotion, and similar troubles have to do with advance in the spiritual life, but they more commonly have to do with the liver in persons that are not nearly so important spiritually as they fancy they are; and in these cases the cook is the particular devil at fault, if they have exercise enough.

One of the chief sanitary evils in our boarding-schools, convents, and similar institutions, is the stupid sameness in the food which may be otherwise unobjectionable. The meat, for example, may be good, but the college and seminary cook sends it into the refectory chilled and clammy, or hot and overdone. In any case it is everlastingly the {209} same. Children can predict a dinner's ingredients a month in advance.

Give children meat twice a day; white flour in their bread, because it is digested better than whole flour; all the sugar they want at meals; milk rather than tea, and tea rather than coffee; but let it be tea, not a dose of tannic acid.

The physical education of girls is neglected. Their general education is effeminate rather than feminine. If a convent faculty grows bold and "modern" it hires a teacher of gymnastics, puts an "extra" on the bill of expense, and ten or twelve wealthy girls play at gymnastics if they are not too lazy. Even if the whole school is obliged to attend the club-swinging and posturing and the other nonsense, little good is done. Girls should be kept out of doors for their exercise, and fresh air is much cheaper than a gymnastic teacher. If school-girls were forced into the open air more, they would not have time for munching caramels over the erotic spasms of Araminta and Reginald in the popular novel, and there would be advantage in the change. The absence of daily, regular, and sufficient exercise renders girls listless, anaemic, sallow, foul-breathed, melancholy, stooped, irritable.

Do not permit boys under eighteen years of age to go into regular training for college track-teams. Their hearts are not strong enough for the strain.

Boys should not use tobacco in any form, but it is useless to try to make them believe this statement. Tobacco stunts a boy, causes dyspepsia, and renders his mind dull. The measurements made for years at Yale, Amherst, and other colleges, by physical directors, show remarkable reduction in the height and chest expansion in tobacco users as compared with boys that do not smoke. Cigarette smoking would not be different from other smoking if it did not so readily tend to excess. Cigarette smoke is inhaled more than the smoke from cigars and pipes, and thus more of the injurious ingredients of tobacco are absorbed.

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If a boy will smoke let him use a good long-cut tobacco which has little or no Perique tobacco in it, in a "Remington," "Edison," or similar wooden pipe. These are pipes with stems of large calibre, and in the stem there is a roll of absorbent paper or pith which keeps the pipe clean. Cigars, no matter how costly they may be, are too strong for a boy and for most men. A poor cigar irritates the throat aside from the regular effect of the tobacco, especially if there is much nitre in the wrapper. Meerschaum pipes are dirty and too strong. The tongue is irritated by a pipe that has a small bore in the mouthpiece: use a mouthpiece that has as large a bore as possible. Cigar smokers should, after cutting off the end of a cigar, blow the dust out of it from the lighting end to avoid inhaling this irritating dust.

AUSTIN ÓMALLEY.

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XVII

MENTAL DISEASES AND SPIRITUAL DIRECTION

It is a well-recognised fact that persons suffering from many forms of beginning mental disease are likely to be affected by an exaggeration of religious sentiment. An unaccountable increase in piety is sometimes the first warning of approaching mental deterioration. It is not hard to understand why this should be, since religious feelings occupy so prominent a place in the minds of the majority of people, and the removal of proper control over mental operations of all kinds leads to an exaggeration, especially of those that have meant most for the individual before. Supposed religious vocations, especially when of sudden development, are sometimes no more than an index of disturbed mentality. Every confessor of lengthy experience has had some examples of this. This makes it important that clergymen should have a knowledge of at least the first principles on which the diagnosis of mental diseases is made. Superiors of religious communities, and especially those that have to decide as to the suitability of those applying for entrance to, or already in probation for, the religious life, need even more than others a definite knowledge of the beginning symptoms of the various mental diseases, and of the types of individuals that are most prone to suffer from them.