Our Schools by Henry B. Jacobs, M. D.

Review and Herald Publishing Association · Takoma Park Station, Washington, D. C. · Nov 12, 1908

Our Schools

By Henry B. Jacobs, M. D.

The Prevention of Tuberculosis Among Schoolchildren

In the past few years great attention has been given the world over to the subject of the relief and prevention of tuberculosis; but the measures provided refer almost wholly to the adult population. Little consideration, outside of France, has been given to the large number of individuals below the age of fifteen, who in the next few years are to become the active working force.

The child of to-day is the adult of to-morrow; the generation of schoolchildren of to-day is the generation of fathers and mothers of a few years hence. Therefore, as long as tuberculosis is allowed to retain a foothold in this generation of children, so long will it hold its sway as a devastating disease among adults.

All authorities upon the subject of tuberculosis are agreed upon the latency of the disease; that is, an infection of tuberculosis does not immediately manifest itself, as does measles, or scarlet fever, or many of the other infectious diseases. It is not possible to predict whether or not a person has become infected; and if so, when he will begin to show the disease. If he is infected, the likelihood is that the disease will remain latent in the system, awaiting such time for its manifestation as shall be brought on by some overexertion or fatigue, some debilitating cause induced by privation, dissipation, overstrain, or illness. It is safe to say, perhaps, that in every case of tuberculosis the infection occurred from two to ten years before its final manifestation. Hence the cases of consumption which begin to be numerous after the fifteenth year must have had their inception, their infection, within the school-days. . . .

Indeed, many eminent authorities upon tuberculosis, especially in France and Germany, are firmly convinced, not only by their reasoning, but by their clinical and laboratory experience, that all tuberculous infections are made in infancy and childhood, the disease remaining latent until from one cause or another the resistance of the individual is reduced, and the disease becomes manifest. This may be an extreme view, but the instances of childhood infection are so numerous that these views merit careful consideration.

I allude to these facts to make it evident to you how important are the years of childhood, how essential it is that during these years every precaution should be taken not only to prevent infection but to protect the child's physique, and to improve his powers of resistance, so that he may pass through the school period, and enter into the years of work, with a constitution not only not undermined by his social life, but rather so strengthened and so fortified by a knowledge gained in the schools of how to preserve it, that he may undertake life's burdens with every expectation of meeting and coping with them successfully, at least so far as health is concerned.

It is evident, therefore, that the ultimate eradication of tuberculosis rests largely with the coming generation; that is, with the schoolchildren of to-day; and in solving the problem, the mothers and guardians of children, and the teachers and other school authorities, must be the active factors.

Particular responsibility devolves upon the schools. They are the intelligent element in the working force. As tuberculosis is essentially a disease of poverty and ignorance, it is too much to expect that parents in such conditions can give instruction or care to their children at all commensurate in value to the instruction and care possible in the school. This may seem to teachers a large responsibility, but surely it is a responsibility worthy of their highest and most devoted efforts. When they recall that one out of every ten children is likely to die of tuberculosis within the next fifteen years, should it not stir every instinct within them to make all effort possible to protect and save this tithe of the bright, happy lives whom they see sitting before them daily?

There are many practical ways in which the school authorities and teachers can make effective the hope that the schools shall become forceful agents in this great work. In the first place, the buildings themselves in which the schoolchildren are housed should receive the utmost thought and care, to fit them to protect the health of all those who come to them. . . .

Now a few words as to the manner in which schoolhouses are managed. Are the rooms kept clean? Are they swept only after scattering wet sawdust? Are they dusted with a damp cloth rather than with a feather broom? Is the drinking-water pure? Are the drinking-cups clean? Are there provisions for the children to wash their hands? Are the toilet-rooms thoroughly sanitary? Do the teachers understand the value of proper ventilation? Are the school library books sterilized from time to time? Has the system of passing study-books on from one pupil to another been abandoned? Nothing can be more important than cleanliness of the schoolhouse in all its parts. Its effect upon the health of the child is not more important than its effect upon his mind, and it should be the duty of some thoroughly competent supervisor, preferably a capable woman, to see that these conditions exist. . . .

The teaching of hygiene should be considered of first importance. In the first year of school life, the teaching must be largely suggestive and by example, taking care to regulate the habits of the little ones in hygienic grooves,—that they wash their hands before eating luncheon; that they wipe their feet on the door-mat; that they do not spit upon the floor; that they do not turn the leaves of their books by first wetting their thumbs in their mouths; that they do not moisten their pencils with saliva; that they keep their desks and books neat and clean.

From such elementary instruction in hygiene as this, and the formation of automatic habits of health, the teaching can broaden out as the age of the pupils increase, until pupils of average intelligence, over ten or twelve years of age, shall be given extensive courses in hygiene and in the nature of infectious agents which are harmful to human life. There is no reason why a boy or girl of twelve should not understand very fully why certain groups of mosquitoes are dangerous to health, or why polluted water and milk are carriers of typhoid fever; or why he may not comprehend in a practical way the nature of tuberculosis, the common methods of infection, and the best methods for keeping the body in condition for resisting it.

All teaching which has as a result the increase of the pupil's love of nature and the things of out-of-doors will aid in making possible the sound physique so desirable. The school garden, introduced in some of our cities, is doing much good; and many other methods will suggest themselves to teachers interested.

It is not by any means so important to turn out a learned boy or girl as it is to turn out a healthy one, who knows and appreciates the value of health and the right course to pursue to preserve it. New text-books will be needed; graphic diagrams and exhibits adapted to the ages of the pupils, illustrating hygienic subjects, how to live and keep well, what to avoid, are extremely valuable, and must find a place in schoolhouses. Miniature tuberculosis exhibits in all the schools would help largely. It is amazing to see the interest which children take in such things, and with what clear understanding they talk about them.

Probably there is no body of men or women in the community who are in a position to do so much toward the ultimate eradication of tuberculosis as the school-teachers; for it is to the instruction and the example in the schools that we must look for the final solution of the problem.—Henry B. Jacobs, M. D.