Lewis M. Terman

“ Physiology, pathology and bacteriology, as well as psychology and sociology, would have to be taught in their relations to the ultimate work to be done, not as so many unitary and complete sciences. Even the first three years ought to be conscious of the professional end.
A school health officer, the product of such a school, would be of far greater service to education than is the usual school physician and would probably be worth more to society in the long run than a dozen well-trained practitioners. At least one such specialist in child hygiene is needed for every 2,000 school children. ”

“ Is exercise thus taken better in the long run than none at all?
Is it true, as certain recent researches suggest, that forty or fifty per cent, of all school children contract tuberculosis at least once before the end of the school course? How does the incidence of tuberculosis among school children vary with different climatic, social and industrial conditions, and with different methods of school sanitation? Probably two million children now in our public schools will die of this disease. ”

“ Teachers have simply found physical defects an impediment to the pupil's school progress and desire their removal. The school doctor spends some three to six minutes in the examination of each pupil, looking only for the gross and external symptoms of defectiveness. Having strictly the point of view of the physician, his search is for disease. His training has not fitted him to scent out delicate, incipient deviations from the normal nor to see the necessity of doing so. He does not have a biological conception of the functions of child hygiene. ”

“ What sports can safely be indulged in by children of different ages? Can any one state authoritatively what percentage of 16-year-old boys ought to attempt the five mile run? Might not research (research along these lines is now as rare as it is precious) teach us more reliable methods of diagnosticating athletic fitness and unfitness? (Professor Clark Hetherington is authority for the statement that not one physician in a thousand can make this determination.) What are the permissible limits of athletic specialization? What is the relation of muscular power to mortality and morbidity? ”

“ What is the exact nature and extent of the effects of school life upon the vital processes and upon growth? What changes, for example, does the child's blood undergo during the school year in number of red and white corpuscles and in percentage of hæmoglobin? What happens to the blood during a well-spent summer vacation? How does the sedentary work of the school affect the growth of the heart and its muscular force? How common is malnutrition among school children, and what are its causes? To what extent is the school responsible for the curse of constipation? ”

“ The human eye was evolved to satisfy the demands of ordinary vision—that is, to make on the average 15 or 20 movements per minute, under conditions which permit frequent shifts of accommodation and convergence. The work of the school demands of the immature eye that it execute for several hours a day an average of 150 to 200 separate movements per minute with as many rifle-aim fixations and with a uniformly intense strain of the muscles of accommodation and convergence. What is the relative importance of these factors as compared with heredity in the etiology of ocular defects? ”

“ What conditions of health obtain among the one-half million school teachers in the United States? What kind of physical constitution does the profession attract? How many are tuberculous? What proportions suffer from insomnia, obsessions, neurasthenia, eye-strain, headaches, heart-disturbances, indigestion, constipation, or other functional derangements? ”

“ What physiological changes are induced by the high temperature and low humidity of ordinary school-room air? Is it true, as recent experiments suggest, that the goal for which the mechanical engineer strives in the ventilation and heating of a school building, that is, the maintenance of an absolutely even temperature and the avoidance of perceptible draft, is the worst possible condition that could be secured? ”

“ Nor is it reasonable to suppose that man presents any exception to the biological law that the ultimate survival of an organism is threatened whenever it is subjected to conditions of environment widely different from those which directed its evolution. ”

“ How do the results of home study compare in quality and quantity with school study? Is there much or little ground for the frequent charges of overpressure made against the schools? Is school overpressure responsible for any of the recent and marked increase in child suicides? ”

“ The introduction of universal education has changed the whole life of the child from one of active to one of sedentary occupation. As stated by Gulick, "so extensive a readjustment of the life habits of the young of a species has never before been attempted." ”

“ What are the special characteristics of school dust? Which kinds are most injurious? What part does dust play in the dissemination of school diseases? What are the exact results following the introduction of the vacuum cleaner in the school? What are the indirect effects of pure air on the processes of nutrition and growth? Can school air be made hygienic? ”

“ To appreciate the importance of the school health officer we need only to enumerate some of the problems most in need of investigation by men scientifically and specifically trained for the purpose. The following are some of these questions—not one of which can be satisfactorily answered in the light of our present information. ”

“ Of the 18,000,000 children now in the public schools, the lives of probably a half million will be rendered miserable failures because of one or another of the neuroses. May we hope that scientific research in the etiology of nervous diseases will make it possible to segregate the "emotive" cases and apply a psycho-prophylaxis which shall lead them to a normal mental life? ”

“ Instead, excessive burdens are laid upon functions and organs never intended by nature to endure them. If only the intentions of nature were respected during the period of growth and development the problem would by no means be so serious. ”

“ As things are, it compares not unfavorably with professorships in colleges and normal schools, for which we have a constant oversupplying of young Ph.D. candidates willing to serve an indefinite period of apprenticeship as underlings, if only the coveted promotion with permanency of tenure can be reasonably hoped for in the end. Indeed, the rising young profession compares in its rewards not unfavorably with the practise of medicine itself, thanks to what Flexner calls the "enormous over production of physicians." ”

“ Medical inspection, though spreading at a tremendous rate, is still new with us, and doubtless as the profession becomes more specialized and more standardized it will receive as well as merit higher remuneration. ”

“ The physician's training does not qualify him for the many sided tosh of adapting the program and environment of the school to the health and growth needs of the pupil. The main purpose of this article is to suggest tentatively and somewhat roughly some of the more important lines of professional preparation necessary for those who are to work in any field of child hygiene in the public schools. ”

“ Civilization has necessitated a tremendous readjustment of life habits. The factors which controlled and directed the evolution of the human organism have in large part become inoperative. Our modes of sedentary life tend less and less to bring into play the physical traits which were of most teleological value in the primitive struggle for existence. ”

“ What is the minimum size of type that should be permitted for children of different ages? What are the optimum norms for width of stroke, spacing of letters and words, length of lines, color of paper, and intensity of light? Is the complete conservation of vision possible? ”

“ Is it true that keeping the relative humidity of the schoolroom air up to 50 or 60 per cent., the temperature down to 60 degrees or below, and permitting perceptible drafts which will keep the skin practised in the exercise of vaso-motor control should be matters of far more concern than avoiding the usual slight depletion of oxygen or the excess of carbon dioxide? Is respired air poisonous? ”

“ Finally, could men be found in sufficient numbers who would be willing to pay the price in time and strenuous effort involved in such a training for the modest remuneration the schools would offer? No reason appears why there should be any dearth of candidates. ”

“ Over half of the pupils fail to progress through the grades at the expected speed. What are the causes of retardation? To what extent is it an expression of congenital mental deficiency? How many mentally deficient children are in our schools? ”