NECESSITY FOR TEAGHING 
ip Schools 
By V. 6. GeeK, M. B. 
HEALTH OFFICER, NASHVILLE, TENN. 
Brandos Printing Company, Nashville, Tens. NECESSITY FOR TEACHING 
Hygiene in Schooes. 
BY 
— 
W. C. COOK, M. I). 
Health Officer, Nashville, Tf.nn. 
Read Before and Unanimously Adopted by the Ninth Inter- 
national Medical Congress, Washington, D. C., 
September 5-10, 1887. 
NASHVILLE: 
The Brandon Printing Company. 
1887. DEDICATION. 
This brochure is dedicated to the educational authorities of 
public and private schools, medical colleges, and universities of 
Nashville, with the hope—since it received recently the unani- 
mous adoption and recommendation of the largest number of 
medical men ever assembled, i. e., “ The Ninth International Med- 
ical Congress”—that it will lead to the introduction into the 
curricula of schools a proper method of teaching Hygiene, thus 
promoting the public health. 
THE AUTHOR. 
Nashville. NECESSITY FOR TEACHING HYGIENE IN SCHOOLS, 
by w. c. cook, rvr. d. 
Health Officer, Nashville, Tenn. 
Notwithstanding the efforts of sanitarians in recent years to 
enlighten the world upon the importance of public hygiene as a 
most economic and essential element in human progress and hap- 
piness, the sad fact still remains that the greatest obstacle in the 
way of advancement is ignorance and consequent indifference of 
the masses upon this vital question. This is truly shown by the 
opposition with which vaccination is met by a large per cent, of 
every community, although for nearly a century it has been 
demonstrated to be an unfailing preventive of a most loathsome 
and dangerous disease. This was clearly evident among the 
negroes at Nashville during a fearful epidemic of small pox in 
1882-3-4. They have but little fear of small pox, believing 
it to be a God-given disease. The more superstitious of them 
regard it as an evidence of religious courage, mortification of the 
flesh, and acceptance with God, to bravely face it, as well as a 
direct visitation of Divine Providence. Heuce, they firmly believe 
and say, when the vaccinator proposes to protect them by the 
operation, “Go ’way from here wid your scratch pins. You can’t 
keep off small pox. God gibs us dat, and you can do no good wid 
your baccinate. If I’s gwiue to hab de small pox 1’s gwine to hab 
it.” Some affect to believe that the doctor vaccinates with small 
pox matter, or some poisonous substance, which gives them dis- 
ease and kills. So a large per cent, of the lower class of negroes, 
and many of the same class of whites, have never submitted to 
the operation, and never will. It is frequently the case when 
small pox appears in a family, and all the other members are un- 
vaccinated, that they refuse to heed the admonition of the doctor 
and be protected; hence, the contagion spreads from one to an- 
other. Another reason why the disease has been so difficult to 6 
manage is the refusal of the afflicted families to maintain isolation 
of cases. So, from ignorance and superstition mainly, a large por- 
tion of the sick people refused to enter the hospital, or to be vac- 
cinated or isolated, and so its ravages were continued for more 
than two years. 
As knowledge has extended other diseases have alike been 
proven to be caused by or dependent upon such conditions as are 
certainly avoidable. Typhoid fever, dysentery, diarrhea, and 
other forms of bowel troubles have many times been demon- 
strated to be caused by contaminated drinking water. Klein has- 
shown that scarlet fever is a disease derived from the cow through 
the medium of the milk. Measles, diptheria, and possibly all 
infectious diseases, in most instances, are controlable or prevent- 
able. Much of the ill health of all communities is known to result 
from the unsanitary conditions which are found to exist, and yet 
how impossible often it is, under the prevailing insubordination 
and general lack of information upon the necessities of hygiene 
among the masses, for health officers to induce or enforce a com- 
pliance with rules and regulations for their removal. 
This lack of information and consequent indifference as to san- 
itary methods is not confined to the people only, but is often as 
striking among those who are called upon to represent them in 
the legislatures of the country. Like them, they have not yet 
been brought to the proper study of the problem. An intimate 
acquaintance with a number of Tennessee legislatures enables me 
to state that most members will only endorse and promote such 
measures, as they say, “as my people want,” with a natural dispo- 
sition not to encourage anything new unless there is a manifest 
demand for it. 
My observation, with much evidence besides, goes to show that 
in large communities the food supply, especially live stock and 
dressed meats and sausages, offered for sale should receive not 
only closer inspection by health officers and boards of health, but, 
with a view of securing a purer supply, should be the subject of 
special legislation. I am iuformed by butchers and the inspection 
of our sanitary officers that often sick, poor, bruised, and tired 
beef cattle are received or offered for sale as food in our market. 
Adulteration of many of the chief articles of diet, such as butter, 
syrups, teas, cauned goods, spices, etc., are known to exist, espe- 
cially in larger cities, as New York, Philadelphia, Boston, and else- 
where. In the recent legislature of our State a well-prepared 7 
bill was introduced with the view of securing the proper inspec- 
tion of live stock, dressed meat, and sausages intended for food 
in cities of over 70,000 population at least, but the ready defeat of 
the measure showed conclusively how little sympathy or interest 
the average legislator has in sanitary affairs. The bill was voted 
down in the Senate by twenty to four, upon the presumption, as 
an honorable senator remarked to the writer, “that it was a slap 
in the face of the farmer, and was thought to operate against his 
interest”—as if the farmer, in ottering his meat for sale in the 
market, has greater rights than those who buy and eat it. Many 
States in this and other countries protect public health and trade 
by rigid laws upon the subject. The active opposition displayed 
by our lawmakers as to the bill clearly shows how far behind we 
are of the progress and enlightenment of the age. 
Health officers, boards of health, physicians, and sanitarians 
should feel an especial obligation resting upon them to renewed 
effort in educating the masses upon this and kindred subjects by 
a more thorough dissemination of sanitary knowledge. It is said 
that when the people of Great Britain discovered that more than 
one hundred articles were adulterated, the British Parliament, as 
long ago as 1815, passed the best law extant, and since known as 
the “Food and Drugs Act.” The present legislature passed a law 
looking to the manufacture of a purer article of candy, which, 
while it is to be certainly approved, it is nevertheless difficult to 
see that a similar bill to secure pure and wholesome meats is less 
important. We are liable to be imposed upon by having placed 
upon our market cattle afflicted with Texas fever, pleuro-pneumo- 
nia, tuberculosis, and other contagious diseases among cattle in 
the absence of authorized inspection, which are calculated to prej- 
udice the health of the people. The popular mind should be 
brought to realize the fact that in divers ways they are being im- 
posed upon either by ignorance or the greediness and unscrupu- 
lousness of vendors of articles supposed to be necessary for their 
health and comfort. Medicines, even, the first and last means to 
which we resort for the relief of suffering humanity and the pro- 
longation of life, are alike subject to adulteration, or else placed 
upon the market, with flaming advertisements, in the shape of 
some worthless elixir, a panacea for some or all the ills to which 
human flesh is heir. Krauss, chemist, of Memphis, recently ana- 
lyzed a specimen of a proprietary medicine under the extrava- 
gantly advertised name “Tasteless Syrup of Quinine,” highly 8 
recommended, he states, by two very reputable physicians of my 
own town (Nashville), and “found it not to be quinine, but pure 
commercial cinchonine, the basest of all cinchona alkaloids.” This 
is only one instance of thousands similar that have come to light. 
In these degenerate days the proper tiling to do would be to have 
all articles intended for food or medicine for man subjected to au- 
thorized and competent inspection. To do so, the people must bo 
taught the necessity. Once thoroughly informed, all needed legis- 
latiou and compliance therewith would follow. 
In order to secure, with greater efficiency, necessary laws, and 
to promote in the highest degree public hygiene in all of its de- 
partments, every effort should be made to instill its principles into 
the popular mind. 
For this the first class to whom we should appeal is the medi- 
cal profession itself. They are by nature, education, and practice, 
the guardians of the health of the communities in which they live, 
and from every consideration better acquainted with the sanitary 
demands which surround them than any other class of people in 
their midst. Moreover, they are usually faithful workers for the 
public, without money and without price. They only need to 
recognize a little more sharply the fact, and act accordingly, that 
preventive medicine is the medicine of to-day, and, as Dr. Brunton 
says, perhaps in the near future doctors will be paid rather to keep 
people well, than to treat them when sick, observing that “this 
branch of medicine has been greatly aided by the recent increase 
of our knowledge of the life history of microbes, and their action 
in causing disease. Our power to prevent disease will become 
greater when we know accurately the action of various drugs in 
destroying these microbes, or preventing their growth.” 
Medical practitioners are invaluable coadjutors to health offi- 
cers in that they constitute a vast army of thinkers and readers, 
who are therefore enlightened and efficient instructors, or may be- 
come so, of the modern gospel of sanitation among the people. 
Instead of becoming alienated they should be more co-operative 
in all that tends to lessen human suffering and lengthen human 
life. Sanitation, or preventive medicine, is of recent growth, but 
in this country, as elsewhere, like all new enterprises, has had to 
withstand old customs, habits, and ignorance of the people from 
whom, under our form of government, all laws must spring and 
be sustained in order to be effective. The prime duty, then, of 
health officers and medical men is to educate the masses as to the 9 
importance of statutes providing for the successful application ot 
all measures necessary for the removal of all causes operating 
prejudicially to the public health. 
In my held of operation, as County Health Officer, I have been 
compelled to observe, with regret, a large measure of laggardness 
and indifference in sanitary measures among my professional 
brethren, as is shown by their neglect in reporting the existence 
of infectious diseases as urged, as well as in many other things. 
They should realize that to prescribe sanitation is as much their 
duty as to prescribe calomel, and that, therefor, they have the 
same right to take a fee. It does not follow, therefore, that in 
urging the application of sanitary principles he necessarily de- 
stroys his chances for income. If so, upon the same principle 
he would continue to keep his patient sick. The doctor thrives 
best and longest who, with any and all measures, restores his pa- 
tient quickest. Such considerations of selfishness should be aban- 
doned by them, and at once become leaders in sanitary progress. 
As Hartshorne remarks, “ practitioners of medicine have need 
to be thoroughly versed in hygiene for its uses in the treatment of 
their patients, and that air, water, food, sunlight, and ocher natu- 
ral agencies, as they are dealt with, war either for or against them.” 
The same author says, in “ Annals of Hygiene,” “ One cause for the 
insufficient interest of physicians, so far, in sanitary science, has 
been the general absence of instruction of hygiene in the medical 
schools. Until the University of Pennsylvania established a chair 
of hygiene, for a three months’ course, in 1800, there was, except 
a less distinctly professional course in Harvard College, nothing of 
the kind in this country. In hardly any other medical school to- 
day, in the United States, is there more than a nominal inclusion 
of hygiene, under the wing, so to speak, of physiology. This 
ought not so to be. Hygiene, coming naturally between phys- 
iology and pathology on the one hand, and therapeutics on the 
other, ought to have a full place in every medical curriculum. It 
should be granted a professorship to itself, in the winter course, 
with examinations compulsory for every graduate. Only when this 
is done, and the whole acquaintance of the physician with the 
subject is no longer postponed till after graduation, then to be 
picked up, as it may be, here and there, only then will it be possi- 
ble for the members of the medical profession fully to maintain 
the place which is theirs of right, that of thoroughly equipped 
scientific and practical leaders in sanitary progress. 10 
The time may, indeed, and ought to come, when sanitary coun- 
sel may be called for and professionally given, in a manner analo- 
gous to that of legal advice, to prevent instead of only to remedy 
disaster. If a careful man has property to bequeath he consults 
a lawyer about his will. When he has a house or farm to sell, or 
proposes to buy one, a lawyer or conveyancer inspects the title, 
and sees to the proper and safe conduct of the transaction. So, 
why should not the family sanitary adviser be consulted about the 
situation, construction, drainage, and ventilation of a proposed 
new dwelling to be built or bought?” 
All Medical Colleges should set the example by establishing 
regular professorships on public hygiene, and thus assume a prom- 
inence and advantage to which, in the nature of their calling, they 
are justly entitled. Not only in medical colleges should public hy- 
giene be taught, but also in the universities and literary colleges of 
the country ; it should be embraced in their curriculum. System- 
atic and thorough text-books upon the subject should be intro- 
duced, and a faithful study of the subject be enjoined upon the 
pupil. It would be better for all such institutions to employ a 
thoroughly educated physician and practical sanitarian as the 
instructor and lecturer in this department, and at the same time 
supervise and direct the sanitation of the institution; a subject 
of the greatest moment to schools where, at the tender age of 
youth, so mauy are thrown together. Anatomy and physiology 
have, to a limited extent, been taught in many schools for years, 
but in this country I have been unable to learn that text-books 
upon hygiene and instruction thereon have been added to any 
considerable extent. The subject, however, here and there, seems 
to have received some attention. In a recent letter to the writer 
from Dr. Henry B. Baker, Secretary of the Michigan State Board 
of Health, he states: “In Michigan we have, for some time, had 
lectures on sanitary science in our University, at Hillsdale College, 
Albion College, and the State Agricultural College. Some of our 
high schools are becoming interested in the subject.” As a further 
means of enlightenment, leading universities of different States 
could not do better than to imitate the energy, intelligence, and 
liberality of Michigan by securing, in some way, the means neces- 
sary to establish a laboratory of hygiene and physics. He says, 
“We are now breaking ground for a thirty thousand dollar building 
in Ann Arbor, which will be given up to the laboratory of hygiene 
and the laboratory of physics. Five thousand dollars have been ap- 11 
propriated for their equipment.” While in European countries 
such laboratories are numerous, in the United States, perhaps, 
there are noue except at University of Harvard, Johns Hopkins 
University, and prospectively at Ann Arbor. 
Public Schools. 
Another means for further and more rapid and effective diffusion 
of a knowledge of hygiene would be to teach it in the public and 
private schools of the country, especially to the advauced classes. 
Latin, Greek, Hebrew, algebra, rhetoric, logic, high art, and music, 
and many other things are taught in such schools that in after life 
are found to be comparatively useless to the masses in their strug- 
gles for bread. Could not a knowledge of hygiene be imparted in 
these schools, by systematic teaching, which, in the serious march 
of life, would be equally, if not far more important! Is it not as 
practicable to instil a knowledge of hygiene into the minds of 
pupils as that of dead languages, philosophy, or political economy ? 
Is it more valuable, or productive of more happiness, to possess a 
knowledge of belleslettres than to understand how the human 
body is dependent upon and effected for life or death by surround- 
ing elements and conditions? Is a knowledge of logarithms, 
trigonometry, or calculus, more conducive to health and wealth 
than a knowledge of house construction, home sanitation, or pre- 
vention of epidemics ? I would not be understood as underrating 
the knowledge acquired by pursuing the usual curricula of our 
schools, but submit that the minds which grapple so successfully 
with their intricate and ornamental prolrlems can as easily, and 
with far more practical advantage, master the principles of sani- 
tary science. 
According to the census of the United States in 1880, there 
were attending the various schools of the country 9,040,160 pupils. 
Suppose this number, or even half, with graded and suitable text- 
books, were being instructed, as in other studies, in the principles 
of hygiene? Who could compute the wonderful revolution that 
would inevitably follow upon the subject of public health within 
a dozen years in this country ? What a diffusion of knowledge, 
and influence for good, would be wrought all over the laud, as they 
would enter upon the pursuits of life? What more potent method 
could be adopted for the dissipation of the incubus of ignorance 
which prevails as to the anatomy, physiology, and hygiene of the 
human body? I once asked an intelligent lawyer, as we were 12 
viewing a manikin, to point to the place where he thought the 
stomach was. Placing his linger on top of the sternum he said, 
“There, there it is.” I replied, you are mistaken. “Well,” said 
he, “there is where I feel sick when I puke.” As truthfully re- 
marked by the Rev. J. L. Patton, of Michigan: “There is scarce 
any subject of human knowledge of which the mass of men know 
so little as their own proper selves. It is hard to illustrate. Here 
is a man of mature years who, when asked the other day what 
the thorax is, said that it is a big vein that runs down the back- 
bone. But that man is a practicing surgeon, had performed an 
autopsy on the body of a murdered woman, and made this answer 
on the witness stand of the circuit court. What, then, must be 
the condition of the laymen?” Further: “It is said, and there 
is good show of authority for it, that knowledge is power. George 
Eliot asks why nobody ever speaks of the power of ignorance. 
Ignorance is not properly power. It cannot tunnel a mountain— 
it is the mountain to be tunneled—lies in the way of every proper 
accomplishment by power. It is weakness to the mind, and 
weakness and death to the body. This ignorance of men in mass 
as to the anatomy of their own persons and of the physiology and 
hygiene pertaining thereto, means ignorance of the laws of 
health and their consequent violation and penalty. Sanitary 
reform will make no headway worth mention through such igno- 
rance. It is not enough that some physicians and a few experts 
and specialists be intelligent as to sanitary science. The people 
will not gather themselves up and do these things merely because 
they are told that this will be best for them. To the end that 
they may live long and to best purpose, the object to be attained, 
people must themselves become intelligent—how to build their 
homes and cities, how to eat and how to sleep, how to work and 
how to rest, how to keep the earth clean where they are, and the 
air, and the water, also themselves and everything about them. 
They must know how best to keep up the wholesome balance be- 
tween the activities of the physical man and those of the mind. 
They must also know how best to keep every part of their own 
animal economy at its own proper work, and fully up to the re- 
quirements upon it of the whole man. They must also see how 
these things are necessary. All this may be the work properly of 
the common schools of the land, but it is the proper part of sani- 
tarians to call for it. If our boys and girls, at the age of sixteen 
years, could chart the arterial and venous system of the human 13 
body, and have sufficient knowledge of its functions and hygiene, 
they could afford to be ignorant of the river systems of Europe,. 
Asia, and Africa, and if they could also have knowledge of the nerv- 
ous system, the system of digestion and nutrition, the respiratory 
system, and the mechanics of the bones, with their several func- 
tions and hygiene, they could afford, even as a means of mental 
discipline, to leave out the rest of their geography, their definitions 
of dictionary words, and part of their mathematics. This would 
give foundation for sanitary reform such as might, in time, bring 
human life up to its natural duration of a hundred years.” 
In a recent letter from Dr. Ezra M. Hunt, Secretary of the State 
Board of Health of New Jersey, and teacher of hygiene in the 
normal school at Trenton, he says, with reference to teaching hygiene 
in the public schools: “I have thought much upon the subject 
upon which you speak, and have the conviction that we will not 
reach great reforms in the care of public health until our children 
are taught in the schools what are the conditions of health. This 
will not come by the mere teaching of physiology. We must 
directly teach hygiene. One of the first things is to teach teachers. 
I do not believe any text-book takes the place of the teacher. My 
own classes enjoy it as much as any study they have, and get out 
of it science and mental training as well as practical facts.” 
In view, therefore, of the benefits to be derived from a diffused 
knowledge of hygiene, may it not be pertinently suggested that 
sanitarians throughout the land arouse themselves to increased 
efforts to have the subject embraced in the curricula of the schools, 
and advise the teaching of the subject be entrusted to thoroughly 
competent physicians and practical sanitarians? In this way there 
will be indelibly impressed upon the minds of youth valuable facts 
pertaining to the conservation of health, which is, indeed, individ- 
ual as well as public wealth. 
Should this paper contribute in any wise to the agitation or 
adoption, by the various school authorities of the laud, the views 
herein imperfectly presented, then would I feel conscious that hav- 
ing thus complied with an invitation to write upon the subject of 
public hygiene for the Ninth International Medical Congress had 
not been wholly in vain. 
Nashville, Tenn., August 12, 1887. 14 
Hygiene in Schools. 
The Medical Register Saturday, September 10, 1887, in its re- 
port of the meeting of doctors, lias the following: 
“ Dr. W. C. Cook, Healtli Officer, of Nashville, read a paper on 
iTeaching Hygiene in Schools,’in which he advocated that hygiene 
be added to their curricula; that medical colleges establish regular 
professorships. Universities and colleges should employ suitable 
text books and competent medical men and sanitarians in order 
to properly impress the minds of pupils. The section unanimously 
indorsed the sentiments of the paper, as was shown by the follow- 
ing resolutions, offered by Dr. Benjamin Lee, of Philadelphia: 
‘ Resolved, That this section cordially indorse the suggestions of 
Dr. Cook’s paper on tne necessity for the teaching of hygiene in 
schools, and recommend to the Congress the passage of the follow- 
ing resolution: 
Resolved 1. That it is the sense of the Ninth International Med- 
ical Congress that every medical college should place the chair of 
hygiene on its curriculum, and on an equal footing with the other 
regular branches of instruction. 
2. That in all universities, colleges, and high schools, hygiene 
should form a compulsory part of the course of study, and should 
be taught not simply through text-books but by educated physi- 
cians. 
3. That in all public schools the teaching of hygiene should 
form a prominent and essential feature. 
4. That every State legislature should establish a museum and 
laboratory of hygiene.’ ” 
The resolutions were adopted not only by the section of hy- 
giene, but also by the entire Medical Congress.