CHAPTER XX

HEALTH AND SANITARY CONTROL

CONSIDERED

The Physical Function of State Education. in the light of ultimate personal and social value, any educational scheme designed to serve a modern democratic state must accomplish several distinct, though related, ends. It must contribute, first of all, to the establishment and acceptance of the standards of individual conduct that make possible those sympathetic and mutually helpful relations underlying all social organization and progress; in other words, an ethical end, the constituent elements of which are appreciation and sympathy. It must contribute to the development of individual aptitudes and capacities requisite for participation in productive economic life. It must, furthermore, provide those conditions and means for the best protection and development of physical energy and vitality. Out of these three ends is compounded the larger primary purpose of the public school system, the strengthening and enlargement of the capacity of a people for those higher forms of political action which enable effective coöperation of all for the common welfare. The capital, however, with which society must conduct its civic, economic, and ethical affairs is derived in the last analysis from its own physical constitution. This constitution is grounded in the school and subject to important change through public education.

The regimentation of children in the state school has given to the physical end of public education a new and magnified significance. This significance is evidenced by the increasing suzerainty of the state over the physical conditions surrounding children, within and without the school. Their protection from infection and contagion, and from all other conditions

inimical to life and health during the years claimed by the state for education has resulted in the exercise of the police power of the state-most generally through state and local boards of health in a way calculated to provide some certain guarantee that education will increase and not diminish the chances for health and physical efficiency.

I. MEDICAL INSPECTION

Numerous laws authorizing the medical inspection and physical examination of school children have been enacted since the passage of the first law by Connecticut in 1899. The first mandatory law was that of Massachusetts (1906) which in its amended form has served as the basis for the principal portion of legislation on this subject in other states.

[Massachusetts Law concerning Medical Inspection of Schools (Acts, 1906, Chap. 502, as amended).]

SECTION 1. (As amended by chapter 257, Acts of 1910.) The school committee of every city and town in the commonwealth shall appoint one or more school physicians, shall assign one to each public school within its city or town, and shall provide them with all proper facilities for the performance of their duties as prescribed in this act; and shall assign one or more to perform the duty of examining children who apply for health certificates in accordance with this act: provided, however, that in cities wherein the board of health is already maintaining or shall hereafter maintain substantially such medical inspection as this act requires, the board of health shall appoint and assign the school physician.

SECTION 2. (As amended by chapter 257, Acts of 1910.) Every school physician shall make a prompt examination and diagnosis of all children referred to him as hereinafter provided, and such further examination of teachers, janitors and school buildings as in his opinion the protection of the health of the pupils may require. Every school physician who is assigned to perform the duty of examining children who apply for health certificates shall make a prompt examination of every child who wishes to obtain an age and schooling certificate, as provided in section sixty of chapter five hundred and fourteen of the acts of the year nineteen hundred and nine, and who presents to said physician an employment ticket,

as provided in said section, and the physician shall certify in writing whether or not in his opinion such child is in sufficiently sound health and physically able to perform the work which the child intends to do.

SECTION 3. The school committee shall cause to be referred to a school physician for examination and diagnosis every child returning to school without a certificate from the board of health after absence on account of illness or from unknown cause; and every child in the schools under its jurisdiction who shows signs of being in ill health or of suffering from infectious or contagious disease, unless he is at once excluded from school by the teacher; except that in the case of schools in remote and isolated situations the school committee may make such other arrangements as may best carry out the purposes of this act.

SECTION 4. The school committee shall cause notice of the disease or defects, if any, from which any child is found to be suffering to be sent to his parent or guardian. Whenever a child shows symptoms of smallpox, scarlet fever, measles, chickenpox, tuberculosis, diphtheria or influenza, tonsilitis, whooping cough, mumps, scabies or trachoma, he shall be sent home immediately, or as soon as safe and proper conveyance can be found, and the board of health shall at once be notified.

SECTION 5. The school committee of every city and town shall cause every child in the public schools to be separately and carefully tested and examined at least once in every school year to ascertain whether he is suffering from defective sight or hearing or from any other disability or defect tending to prevent his receiving the full benefit of his school work, or requiring a modification of the school work in order to prevent injury to the child or to secure the best educational results. The tests of sight and hearing shall be made by teachers. The committee shall cause notice of any defect or disability requiring treatment to be sent to the parent or guardian of the child, and shall require a physical record of each child to be kept in such form as the state board of education shall prescribe.

SECTION 6. The state board of health shall prescribe the directions for tests of sight and hearing and the state board of education shall, after consultation with the state board of health, prescribe and furnish to school committees suitable rules of instruction, test-cards, blanks, record books, and other useful appliances for carrying out the purposes of this act, and shall provide for pupils in the normal schools instruction and practice in the best methods of testing the sight and hearing of children. The state board of education may expend during the year nineteen hundred and six

a sum not greater than fifteen hundred dollars, and annually thereafter a sum not greater than five hundred dollars for the purpose of supplying the material required by this act.

SECTION 7.***

SECTION 8. **

II. REGULATION BY STATE BOARDS OF HEALTH

The form and scope of the regulations made by state boards. of health, having in many states the force of law, are illustrated by those of the Wisconsin board, adopted in January, 1913.1

Rule 17. Attendance at School, when Prohibited. All teachers, school authorities and health officers having jurisdiction shall not permit the attendance in any private, parochial or public school of any pupil afflicted with a severe cough, a severe cold, itch, lice or other vermin, or any contagious skin disease, or who is filthy in body or clothing, or who has any of the following dangerous, contagious or infectious diseases to-wit: Diphtheria, smallpox, scarlet fever, measles, whooping cough, chickenpox, mumps, pulmonary tuberculosis, Asiatic cholera (cholerine), yellow fever, typhus fever, bubonic plague, cerebro-spinal meningitis or acute anterior poliomyelitis. The teachers in all schools shall, without delay, send home any pupil who is obviously sick even if the ailment is unknown, and said teacher shall inform the parents or guardians of said pupil and also the local health officer as speedily as possible, and said health officer shall examine into the case and take such action as is reasonable and necessary for the benefit of the pupils and to prevent the spread of infection.

Rule 18. Duty of Parent. Parents, guardians or other persons having control of any child who is sick in any way, or who is afflicted with any disease listed in Rule 17, shall not permit said child to attend any public, private or parochial school or to be present in any public place.

Rule 19. Duty of Teachers, etc. School teachers, pupils or other persons shall not be admitted to any public, private or parochial school who have come from, or who reside in any house or building which harbors, or is infested with any disease listed in Rule 17, or who have recently been afflicted with such diseases,

1 Consult Kerr, J. W., and Moll, A. A., Organization, Powers, and Duties of Health Authorities. (Public Health Bulletin, No. 54, U. S. Treasury Department, 1912) for a comprehensive analysis of the laws, regulations, judicial decisions, etc., for the entire United States.

unless they have the written permission of the local health officer having jurisdiction.

Rule 20. Air and Floor Space. Schoolhouses shall have in each classroom at least fifteen square feet of floor space, and not less than two hundred cubic feet of air space per pupil, and shall provide for an approved system of indirect heating and ventilation, by means of which each classroom shall be supplied with fresh air at the rate of not less than thirty cubic feet per minute for each pupil, and warmed to maintain an average temperature of 70 degrees Fahr. during the coldest weather.

Rule 21. Duty of Health Officers. Local health officers having jurisdiction shall dismiss forthwith any schoolroom in which at least 200 cubic feet of air space is not supplied to each pupil. The school authorities shall without delay make provisions for the pupils in accordance with the requirements stated in Rule 20.

Rule 22. Ventilation. Proper ventilation must be provided in all schoolrooms and when ventilation ducts do not exist, or are inadequate, it shall be the duty of the teacher to flood the schoolroom with fresh air by opening windows and doors at recess and noon time and also whenever the air becomes close and foul. Pupils should be given gymnastic exercises during the time the windows are open in cold weather.

When windows are the only means of ventilation they should be so constructed as to admit of ready adjustment both at the top and bottom, and some device shall be provided to protect the pupils from currents of cold air. The top of the windows shall be as near the ceiling as the mechanical construction of the building will allow.

Rule 23. Heating. It shall be unlawful for any school board, board of school directors, board of education, or other school officials in Wisconsin, to use a common heating stove for the purpose of heating any schoolroom, unless each such stove shall be in part enclosed within a shield or jacket made of galvanized iron or other suitable material, and of such height and so placed as to protect all pupils while seated at their desks from direct rays of heat.

Rule 24. Lighting. Light shall be admitted from the left, or from the left and rear of classrooms. The glass area of windows shall equal at least one-fifth of the floor area of the schoolroom, and no pupil shall be farther removed from the principal source of light than twenty-two feet.

Rule 25. Sweeping and Cleaning. All floors must be thoroughly swept, or cleaned by a vacuum cleaner each day, either after the close of school in the afternoon, or one hour before the