SCHOOL HYOIEHE; 
A PAPER READ BY 
a 
V 
X 
Dr. R. ,T. O’SULLITAjr, 
BEFORE THE 
1ST. ■'ST. OF ZMZEZDXCIISTE, 
June 19, 1873. SCHOOL HYGIEHE. 
A PAPER READ BEFORE THE NEW YORK ACADEMY OF 
MEDICINE, JUNE 19, 1873. 
BY 
RICHARD J. O’SULLIYAN, M.D., 
LATE PHYSICIAN AND SANITARY SUPERINTENDENT OP THE DEPARTMENT OP PUBLIC IN- 
STRUCTION OP THE CITY OP NEW YORK ; CONSULTING PHYSICIAN OP THE EASTERN 
DISPENSARY, DISEASES OP THE THROAT AND CHEST ; FELLOW OF THE 
NEW YORK ACADEMY OP MEDICINE; MEMBER OP THE MEDICAL 
SOCIETY OP THE COUNTY OP NEW YORK,' DELEGATE OP THE 
STATE MEDICAL SOCIETY, AND OP THE AMERICAN 
MEDICAL ASSOCIATION, ETC., ETC. 
NEW YORK: 
D. APPLETON AND COMPANY, 
549 & 551 BROADWAY. 
1874. SCHOOL HYGIENE. 
It ought not to require a long argument to prove 
that the physical well-being of the pupils in our com- 
mon schools is as sedulously to be cared for as their 
advancement in knowledge. And yet it is not easy to 
get practical recognition of this truth. Our educa- 
tional system has undergone many a change within a 
few years; branch after branch of study has been add- 
ed to the common-school course, until the latter has 
become in fact academical in its comprehensiveness. 
Where hundreds of dollars used to be expended on 
school-buildings, tens of thousands are expended now; 
every aid to learning, all manner of costly apparatus, 
with books and musical instruments, are furnished with 
unstinting liberality. And the tendency is still fur- 
ther to develop the system, until every child in the 
land may have in its power to secure free of cost the 
broadest and highest education attainable anywhere. 
But at the same time care for the physical well- 
being of the pupils does not advance with equal steps. 
There is no doubt at all that this attempt at one-sided 
development—that is, at developing the intellectual 
faculties to the prejudice of the physical faculties—is 
radically wrong, and sure to lead to disastrous conse- 
quences. These two ends must be steadily kept in 4 
view by the educator, namely, physical culture and 
mental culture, and they must go on with equal pace. 
In the present discourse it is my purpose to offer 
some few considerations on that side of the great school 
question with which as a medical man I am most con- 
versant—the physical side—and I will restrict my re- 
marks to the subject of school hygiene. 
AGE OF ADMISSION. 
I think that the existing regulations with regard to 
the age at which children may be received into the 
schools should be amended. You will find among the 
pupils, children of four years of age. To require of 
such infants that they shall sit still by the hour is to 
impose on them a cruel task. If mere babes are to be 
cared for during a portion of the day in public insti- 
tutions, then nurseries should be established for that 
special purpose, furnished with all needful appliances 
for the comfort and amusement of the little ones. 
What should be the minimum a«;e for admission to 
school ? Some very high authorities would have it 
seven years, saying that no intellectual work should be 
required of a child before it has attained that age. We 
may grant the conclusion here while questioning the 
premises. Seven years is an early enough age for a 
child to be sent to school, not because the mental ex- 
ertion would be injurious to its healthy intellectual 
growth, but because school-life, under its present hy- 
gienic surroundings, is very unfavorable to the child’s 
physical development. 
If intellectual work were the thing that does injury 
to the infant mind at school, then no child could ever 
reach even its seventh year, school or no school. Dur- 
ing those early years it is that the observing faculties are most wakeful, and it is tlien that the groundwork 
of all our philosophies, of all our religions, of all our 
fixed ideas, is laid. Acquisition of knowledge is going 
on at every instant, and the avenues between the outer 
world and the mind of the child are free and open as 
they will be never again. The child’s mind is unfold- 
ing like a fiower to the sun, and knowledge is its very 
life. But this acquisition of knowledge is not a task. 
It proceeds according to Nature’s methods, and attains 
its ends without jar or strain. It cannot, therefore, be 
the intellectual work of the school-room per se which 
is injurious to the healthy growth of the youthful in- 
tellect ; it must be our faulty methods of instruction. 
I should pity the unhappy infant sent to a school to 
learn a language: place that child among other chil- 
dren speaking the language it is desired to learn, and 
in a few weeks its vocabulary will be as full as that of 
its playmates. 
Viewing the question in the abstract, therefore, I 
should say that intellectual occupation or work is not 
inimical to the development of the infant mind; on the 
contrary, it is the very condition of that development. 
When Nature’s processes are followed, the acquisition 
of knowledge, far from being a hateful task for the 
child, is a delightful occupation. But it will be said 
that our system of education is fixed and practically 
unalterable, and that if it has its disadvantages these 
must be borne with. It does, indeed, look as though 
only a very distant future would see that change in our 
educational system which every philosophical mind de- 
sires. 
If, then, our children are destined to find that the 
first steps in school knowledge lie through thickets and 
thorns; if they are to acquire school knowledge only 6 
by methods which are in conflict with the intellectual 
and physical nature of man, we must say that a very 
immature mind or body can come under the influence 
of school discipline only at the certain cost of impair- 
ment : therefore I would suggest that the minimum age 
for admission be between six and seven years. 
DIVISION OF TIME IN SCHOOLS. 
But even though the age of seven years were fixed 
as the minimum for admission to the schools, it would 
still be necessary to modify considerably the routine 
of scholastic exercises. The hours of .study are too 
long, especially in the infant classes. It is extremely 
unwise to require of little children that they shall ob- 
serve silence and sit quiet in their places for any length 
of time. The very condition of the development of 
mental or bodily faculties is use, exercise. But in 
school the child is required to refrain for hours at a 
time from that play of the muscles, from that exhibi- 
tion of exuberant life which is so natural to it—which, 
indeed, is as necessary for it as the inhalation of pure 
air. I have found schools in which the pupils were 
allowed no recess between their entry into the school 
in the morning and the dinner-hour, or between one 
o’clock and the hour of breaking up. Of course I lost 
no time in suggesting the remedy necessary to correct 
such a state of affairs, but, even with the usual fore- 
noon fifteen minutes’ recess, school-life cannot fail to 
have an injurious effect upon the health of the pupils. 
I hope yet to see the routine of school-life brought 
into something like harmony with hygienic require- 
ments. What these are, as ascertained by some of the 
great lights of our profession, I will state briefly. They 
may have the appearance of being extreme, and yet 
they are moderate enough. 7 
First, then, Hufeland would have children spend 
the greater part of their waking hours in physical ex- 
ercise. A child that is not vivacious, playful, alert, 
stirring, will hardly grow to he a vigorous man. 
Schooling must follow the course indicated by Nature; 
it will do only injury if it attempts to set Nature aside. 
But it will perhaps be objected to this that if the 
greater part of the time is to be given to physical ex- 
ercise, then the entire order of school routine, as it 
now exists, is a mistake. Well, men do commit mis- 
takes, and it ought not to cause any very great sur- 
prise if we should detect errors even in our admirable 
school-system. I would not, however, be understood 
as disparaging our school-system, by any means. I be- 
lieve that it is making progress as rapidly as any other 
system or function of our modern life. There would 
be a fearful overturning indeed if every institution, 
and every profession, and every individual, were to be 
sternly required to justify in the Court of Reason their 
every step, their every process, their every judgment. 
Yet when a demand is made that you justify a certain 
course wdiich appears to be in the very teeth of Na- 
ture’s law, it is not enough to plead immemorial usage. 
In the language of the civilians, there is no prescrip- 
tion against a law of Nature. 
Thirty minutes is about the limit, in the infant 
classes, to which quiescence should be protracted. It 
should alternate with other thirty minutes of play, or 
spontaneous muscular exercise. With children of, say, 
nine to twelve, sixty minutes should be the limit. 
There should be spacious play-grounds attached to 
each school-building, with ample sheds for recreation 
in stormy and very hot weather, and it would be very 
desirable if Hufeland’s recommendation of holding 8 
school in the open air in fine weather could be carried 
out. 
But then the expense ! It is a necessary expense, 
and I need say no more. As much cannot be said of 
every governmental outlay. Just consider the de- 
mands now made by military organizations here and 
in Brooklyn for armories and parade-grounds! Our 
schools have a far stronger claim than they, and they 
should be heard first. 
RECREATION MUST BE SPONTANEOUS. 
No military drill-sergeant exercises will afford a 
competent substitute for the spontaneous activity of 
childhood, on which healthy physical development de. 
pends. Such concerted exercises are of the nature of 
a task—they are not recreation. They are too stiff, too 
formal, for the ingenuous minds of children. Their 
own sports and amusements are infinitely better fitted 
to develop their powers symmetrically than the most 
cunningly-devised system of calisthenics in the world. 
CRAMMING. 
What is called cramming is a practice that ought 
to be frowned down by every honest man. It consists 
in loading the memory with a heterogeneous and undi- 
gested mass of dates and rules and formulas, generally 
with a view to demonstrating at a public examination 
or exhibition the excellence of the instruction given at 
a school. There is more wear of brain and more worry 
attendant on the preparation for such exhibitions than 
they are worth. And what does it all amount to? 
Nothing whatsoever. In fact, it is simply mischievous ; 
very, very little of the entire crude mass of knowledge 
so stowed in the memory is ever retained. As a rule, 9 
we might hold concerning mental pabulum as of cor- 
poreal food, that so much is useful and used as is need- 
ful at the time it is taken; any excess is rejected at 
once, or remains only to cause discomfort. Perhaps 
these remarks might be extended a little, and applied 
to the subject of multiplied studies; but I do not care 
to discuss every incidental matter. And yet I cannot 
refrain from just hinting at another analogy here, be- 
tween the admission of knowledge into the mind and 
of food into the stomach. It is found that a few plain 
dishes are more promotive of health than a great va- 
riety of exquisite viands. 
INJURY TO THE EYE. 
In an address before tbe State Medical Society, Dr. 
C. R. Agnew calls attention to the increasing preva- 
lence of asthenopic, refractive, and neurotic difficulties 
among scholars of both sexes. “ These maladies are,” 
he says, “growing rapidly more prevalent in cities, 
schools, colleges, and other centres of civilization.” The 
same complaint is echoed from Germany. In England 
inflammatory diseases of the eye appear to be causing 
some alarm, as the pages of the London Lancet for tbe 
past two or three months will show. The disorders to 
which Dr. Agnew refers have their cause in a deficiency 
of light or imprudent use of the organs of vision, while 
the ophthalmic disorders spoken of in the Lancet are 
due to defective general hygiene. 
The only effectual method of guarding against the 
spread of the last-named disorder is, by a close medical 
inspection of the children attending the schools, and 
the rigid enforcement of the rules of personal and local 
sanitation. The other class of optical maladies are to 
be held in check by introducing into school-architecture 10 
such scientific principles as will insure to the pupils 
abundant light on all sides. The amount of light 
should be equal for both eyes; for, if, in reading or 
writing, one eye has a brighter light falling upon it 
than the other, the pupil necessarily expands or con- 
tracts, in proportion to the intensity of the light. The 
unequal expansion and contraction of the two pupils 
cannot fail to have injurious consequences. To guard 
against these evils, the school-room should be lighted 
from two sides, so that the light coming to both pupils 
shall be equal. 
It would be absurd to expect of a city Board of 
Health that they should care for such minutiae as these, 
all-important though they be in their results. The 
most that can be required of such officers is, that they 
abate nuisances which threaten the public health. But 
when the question is, how shall the children in the 
schools be protected against the diseases incident to 
school-life, the school-system must give the answer out 
of its own resources. The school itself ought to have 
a sanitary code, with sanitary officers in sufficient force 
to carry it into execution. 
YENTILATION. 
It is of supreme importance tliat perfect ventilation 
should he secured for all school-huildings. The first 
thought of the architect who plans a school-house 
should he, how he may hest solve this great problem 
of ventilation. The external appearance of the build- 
ing should he only a secondary consideration. There 
is, in reality, no conflict between these tw~o things when 
they are properly understood—between perfect adapta- 
tion of a building to its destined uses, and artistic 
beauty. Indeed, the beauty of a building must con- 11 
sist in its adaptation to its ends. If it is ill-adapted, 
but yet possessed of a certain pleasing symmetry of 
form, we may say that it is a beautiful object; we 
should scarcely say that it is a beautiful building. 
The problem of ventilation is one of considerable 
difficulty, and we are yet to find its perfect solution. 
In a climate so variable as ours, where the changes of 
temperature are so sudden, and have so very wide a 
range, it is no easy thing to conciliate the antagonistic 
demands for warming and ventilation. 
In our plans we are prone to think much of styles 
of architecture; and, when we have made our choice 
between Grecian and Gothic, we then let ventilation 
provide for itself. A writer in the current number of 
the Sanitarian says: “ It is extremely doubtful if a 
single church” (and he might have added, “or school- 
house”') “now standing in the city of New York will 
be considered suitable, in a sanitary point of view, to 
be worshiped in fifty years hence, without being so 
altered as to be scarcely recognized by its designer.” 
The same writer asks: “ Is not this a good time to 
commence the study, and practice, too, of sanitary 
architecture? There have been a few spasmodic ef- 
forts within the last few years to improve the ventila- 
tion of our buildings; but these efforts have gone only 
so far, in most cases, as to make a few holes in the 
walls, which generally serve to let in cold draughts of 
air, and these are soon shut up in disgust.” Enter a 
crowded class-room in any of our school-buildings in 
winter when the windows are shut. The oppressive 
atmosphere of that room is surcharged with carbonic- 
acid gas, decaying organic matter, and moisture from 
the respiration and perspiration of the inmates. In 
one of Dr. Endemann’s experiments, the air of a class- 12 
room was found to hold—one window being open— 
carbonic acid to the extent of seventeen and two-tenths 
parts per ten thousand. That was surely bad enough, 
showing the presence of this gas in a proportion four 
times greater than the normal quantity. But warmth 
is essential as well as ventilation; and, as the scholars 
were becoming chilled by the current of cold air enter- 
ing through the open window, it had to be closed. 
After ten minutes a new analysis of the air was made, 
and the proportion of carbonic acid was now thirty- 
two and two-tenths per ten thousand. If the window 
had not been again opened, “we might, within one 
hour,” writes Dr. Endemann, “ have reached the abomi- 
nable figure of one hundred and ten.” This test showed 
only the amount of carbonic-acid gas; but the other 
poisonous elements of impure air are at least quite as 
injurious. I do not, of course, pretend to say that the 
air in our schools is generally as foul as this; but no 
sane man will affirm that in any of them the problem 
of ventilation has been any thing like satisfactorily 
solved. It is not for the physician to indicate the me- 
chanical contrivances which are requisite for the solu- 
tion of it. That is a question for the architects, and 
they will answer it, I am convinced, if school-boards 
will require them to do so. Let such boards only bear 
in mind that the “ style ” of a building is not the ques- 
tion, and that the first and foremost care must be to 
secure good ventilation. 
The second annual report of the Massachusetts 
Board of Health includes a paper by Mr. A. C. Mar- 
tin, architect, which offers several valuable suggestions 
as to the proper method of ventilating schools, and to 
that document I refer with pleasure. 13 
CONTAGIOUS DISEASES. 
That no pupil should be admitted to a public 
school who is affected with any malignant or conta- 
gious disorder, would be readily admitted by all. But 
yet there is no doubt that, in certain districts, this plain 
dictate of sanitary prudence is disregarded, and the 
consequence is that skin-diseases and ophthalmic affec- 
tions spread among the pupils. A weekly inspection 
of the scholars, and especially of those applying for ad- 
mission, to be conducted by a physician, would be a 
very desirable measure. 
SMALL-POX. 
With regard to the precautions to be specially taken 
against the spread of small-pox, it is indispensable that 
every pupil should be vaccinated, as the sine qua non 
condition of being admitted to the schools. While I 
was connected with the Board of Education as visiting 
physician, I had the opportunity of witnessing, in a 
very striking way, the efficacy of vaccination as a 
prophylactic against small-pox. Of forty thousand 
pupils vaccinated, not one was attacked by the mal- 
ady, though the epidemic raged through the city for 
months. 
The following passage, taken from a report made 
by me to the Board of Education, suggests, as I think, 
an effectual mode of securing our schools from the rav- 
ages of this dread malady: 
“ In a report made by me to the department, I sug- 
gested that to each child that was vaccinated a certifi- 
cate should be given as evidence of the fact. This cer- 
tificate would be serviceable in case of a return of the 
epidemic, or in the event of the child being transferred 14 
to another school. It would thus save the vaccinating 
corps in the future much trouble. The present by-law, 
which requires that principals should ascertain the evi- 
dence of vaccination, does not, as it seems to me, meet 
all the requirements of the case. In the first place, they 
have no means of acquiring such evidence, save their 
own recollection, or the statement of the pupil, or the 
appearance of a cicatrix. But, when there is question 
of setting up an effectual barrier against the encroach- 
ments of so loathsome a disorder as small-pox, expe- 
rience will decide that such evidence is insufficient. 
The medical man is here, surely, the most competent 
judge, and a certificate under his hand would be satis- 
factory and conclusive evidence. It is a fact of every- 
day experience that the vaccine virus does not invaria- 
bly, and in every case where it is introduced, enter the 
system; and so it will often fail to give immunity 
against small-pox. For this reason it is essential that 
the work of the vaccinating corps should be reviewed, 
after a suitable interval, in order to ascertain whether 
or not the virus has been operative. Without this re- 
view, the work that has been done is incomplete, and 
there is no effectual immunity. No physician claims 
any efficacy for the vaccine virus except where it is ab- 
sorbed ; and therefore it will be pardoned if I insist, 
with considerable emphasis, upon the necessity of the 
review. In some cities of the Eastern States it is the 
rule, I believe, to require of children attending the 
public schools a certificate of vaccination.” 
TIIE SCHOOL A HUMANIZING AGENCY. 
I hold that our schools should be made as nearly 
perfect as it is possible to make them from the sanitary 
point of view. A very large proportion of the cliil- 15 
dren attending them come from the very poor class; 
from the lanes and alleys, from those districts which 
are seldom visited by the scavenger or the garbage- 
cart; from crowded, tumble-down tenement-houses; 
from filthy courts, where the rays of the sun penetrate 
only to quicken the elements of disease, which exist 
in the reeking heaps of filth with which they are 
cumbered. The lives of many children open thus un- 
der most unfavorable auspices, and during the critical 
years of their childhood they find, in the wretched 
quarters which they inhabit, but very few elements of 
good, physical or moral. 
Our school system is for the education, the humani- 
zation of such even as these. The only way to hu- 
manize them, to give them correct notions of order, 
cleanliness, decency, self-respect, is by surrounding 
them during school-hours with a pure atmosphere, in 
the physical and moral sense. Give them in the school 
an abundance of sunlight and of good, pure air. You 
cannot develop moral qualities in the midst of atmos- 
pheric impurity. 
NEED OF SANITARY SUPERVISION. 
Well, if the considerations I have so far advanced 
possess any value, I think the conclusion will be that 
the hygiene of the schools needs to be inquired into 
and promoted. This would require sanitary inspec- 
tion, medical supervision. 
The French Government recently gave to the Royal 
Academy of Medicine, and to the three National Facul- 
ties of Medicine, the right of nominating each one a 
physician, to be a member of the superior council of 
Public Instruction. In the great city of New York I 
think that in the supreme council of Public Instruc- 16 
tion—the central Board of Education—our profession 
ought to be represented, and represented strongly. If 
that body had but one member from the medical pro- 
fession, a resolution, declaring that there is no need 
of sanitary supervision of the schools, could scarcely 
pass that board without a protest. 
DR. AGNEW’S REMARKS. 
Prof. C. R. Agnew, M. D., said : 
I liave "been much interested in the paper of Dr. O’Sulli- 
van, because it calls the attention of the medical profession 
to the most important and complicated subject of the hygiene 
of our public schools. The doctor does not load his paper 
with tabulated statistics or involve us in any doubtful the- 
ories, but gives under actual headings a plain, simple, and 
suggestive narrative, derived from his experience as a school- 
officer, to show how the principles of hygiene are violated in 
our schools. Others will no doubt speak upon the general 
defects in the hygiene of our public schools ; it becomes my 
duty to say a few words regarding the prevalence of those 
forms of eye-disease which may fairly be set down as prevent- 
able. Every practitioner, who is called upon in our city to 
engage in ophthalmic practice, will testify that those forms of 
eye-disease which are directly traceable to over or faulty use 
of the organ are greatly on the increase. Of these maladies 
near-sightedness may be taken as the type and example. 
Near-sightedness is greatly upon the increase, and can be 
traced without the slightest difficulty to the influence of both 
public and private schools. Such a statement, capable of 
easy proof, does not produce the impression upon the public 
mind that it should, because there is profound ignorance 
among the public as to the nature of near-sightedness. Most 
persons think that a near-sighted eye is a good eye to have, 
that it is a “strong eye,” one in which there is an economy of 
visual force, not enjoyed by eyes that see well at long range 
as well as near at hand; that a near-sighted eye may cause 17 
some inconvenience to its possessor during liis early life, to be 
compensated for, however, by his being able to dispense with 
convex glasses for vision after forty years of age. There is 
in this belief just enough of truth to place it among the other 
common popular fallacies. A few near-sighted persons may 
enjoy the alleged advantage; the majority, however, of those 
who are near-sighted do not, but on’ the contrary grow more 
near-sighted as they advance in life, and experience more or 
less serious embarrassments in the exercise of vision for com- 
mon purposes, while many grow blind. Progressive near- 
sightedness is a disease, a disease marked by very uniform 
organic changes of the visual organs, and one which may, un- 
checked, lead to the most disastrous results. The sooner this 
fact is known the better. A knowledge of it will impress 
educators with the duty of so carrying on the education of 
the young as not to induce near-sightedness and other forms 
of eye-disease. We have not yet obtained in this country the 
statistics that have been gathered in older countries, but every 
thoughtful medical man engaged in ophthalmic practice 
knows that the material for them exists. Let me call your 
attention briefly to a few facts gathered by foreign observers, 
and throwing light upon a great hygienic defect in our own 
school-system. 
Dr. Cohn, of Breslau, examined critically two hundred 
and forty eyes of village school-children, and found that more 
than eighty-eight per cent, were in a normal condition. He 
also critically examined the eyes of over 10,000 school-chil- 
dren, and found that in the various grades there wTas a rapidly- 
increasing near-sightedness. The result of his examination 
showed, when tabulated, that the near-sightedness rate was as 
follows: In elementary schools, 6.7 per cent. ; in intermedi- 
ate schools, 10.3 per cent.; in high-schools, 19.7 per cent.; 
and in colleges, 26.2 per cent. In some of the highest classes 
the number of near-sighted students reached nearly sixty per 
cent, of the scholars. 
Dr. Erismann, of St. Petersburg, made a study of the 
eyes of four thousand three hundred and fifty-eight (4,358) 
school-children, and showed that the near-sightedness rate in- 
creased rapidly as he ascended from the elementary or primary 18 
schools to the colleges, and that the sharpness of vision less- 
ened. He found that 30.6 per cent, of the near-sighted 
came from parents one or both of whom were near-sighted, 
and a larger portion of them than of others showed grave 
organic changes in the coats of the eye essential to vision. 
These observers, with others, have proved that the causes 
which led to the production of near-sightedness were, insuffi- 
cient light, badly-constructed tables and seats, and continued 
tension of the overworked eyes. Bad light and position 
tend to embarrass the student in the exercise of that tension 
or accommodation of the eyes which is essential to accurate 
seeing, and to develop near-sightedness. Moreover, the near- 
sightedness thus induced in a child previously from ophthal- 
mic disease is almost invarably progressive, and sooner or 
later complicated by organic changes, threatening blindness. 
Graefe has shown that this exercise of tension, in the effort to 
see, produces disease in the internal tissues of the eyes, devel- 
oping congestion, disturbing the nutrition of the eye, soften- 
ing its tissues, and thus producing an incurable state. The 
baneful effect of this form of eye-disease does not stop in im- 
pairing or spoiling the visual organ merely and entailing 
ophthalmic disease of the gravest kind upon succeeding gen- 
erations, but influences in many ways the bodily health of 
the victim. While the student is bent over a badly-shaped 
desk in insufficient light, and too long confined to excessive 
tasks, he is in other ways injuring his body. The shoulders 
are thrown forward, the chest contracted, the abdominal, 
thoracic, and pelvic viscera are compressed, and the very 
sources of animal life obstructed and damaged. Usually the 
bad air of the school-room is to be added as another cause of 
disaster. The blood, rendered impure by the noxious ingre- 
dients of the stagnant atmosphere, is thrown upon a working 
brain which should have the purest nutriment. The heart, 
lungs, and other thoracic and abdominal organs essential to 
life and nutrition, are impaired by the bending position of the 
student, intent upon his intellectual work, and, failing to get 
that refreshment which they need from properly-aerated 
blood; perform their functions imperfectly, and thus slowly 
but most effectually produce in the sufferer that pale, round- 19 
shouldered, stooping, shambling, stumbling, near-sighted, 
dyspeptic, nervous, sleepless person, who, even though he 
may do something for science, and through it for humanity, 
does little or nothing to improve the tenement of the soul, 
and too frequently transmits to his puny progeny the indel- 
ible marks of his gross though unconscious violation of the 
slightest and most demonstrable laws of health. 
We cannot safely say that our school-houses and our 
school methods are so good that we are in no danger of re- 
peating the mistakes made in some of the German schools 
and colleges. Every one, familiar with our school and college 
life in New York and elsewhere in the United States, knows 
that many of our school-houses are bad in light, bad in ven- 
tilation, bad in desks and seats, bad in the cramming to which 
the students are exposed. That near-sightedness and other 
forms of eye-disease are rapidly increasing, and that the 
chances are against a lad or girl getting what is called a com- 
pleted collegiate education without irreparable damage done 
to health and prospect of future usefulness, is certainly true. 
Medical men, then, have a duty in this matter. They must 
speak calmly, intelligently, and forcibly until their counsels 
prevail. Now, it is not thought worth while to bring a medi- 
cal man into a board of school or college trustees, or even to 
ask formally for his advice in arranging a curriculum. Even 
in our mucli-praised but defective public-school system any 
public-spirited man, however ignorant of the rudiments of 
the science of hygienic education, is more likely to be placed 
in control than a medical man. In the present state of pub- 
lic opinion the abuse cannot be corrected until the medical 
profession, by persistently inculcating correct ideas, so ele- 
vates public opinion as to demand the presence and constant 
personal influence, in every school and college in the land, of 
medical and sanitary experts. To accomplish this desirable 
result this Academy of Medicine may do much, and thus act 
upon the suggestions of the paper of our colleague. 
DR. JACOBI’S REMARKS. 
Prof. Jacobi, after expressing liis tlianks to Dr. O’Sullivan 
for an opportunity of listening to liis paper, and stating that 20 
the doctor had requested him to make some remarks upon the 
age at which children ought to be sent to school, spoke of the 
anatomical and chemical changes taking place in the infant’s 
and child’s brain, in the course of its normal development. 
Embryological studies have been followed with a great deal 
of zeal, but it appears that this zeal does not reach far beyond 
the period of birth. In fact, although the literature on the 
pathology of infancy and childhood is very extensive, the 
monographs and papers on the physiology, particularly of the 
brain and nervous system in general of that period of life, are 
but very few. As far as the relative proportions of the single 
organs of the body at different ages are concerned, we are 
even compelled to look for information on these subjects 
more at the hands of such scientific men as teach, or taught, 
in artists’ schools, than of anatomists proper. 
The functions of the brain depend on its development. 
Fat and phosphorus appear to be in a certain proportion to 
its action ; in the adult it is mostly found in the white sub- 
stance of the brain ; in the embryo and the newly-born, in the 
medulla oblongata. Thus it is, in part, explained how the 
principal functions of the newly-born and infant are concen- 
trated in this part of the nervous system. There is, besides, 
less of those substances in the young than in the old. 
Other differences are exhibited by the percentages of 
water. The more water, the lesser the function. In the new- 
born least water is found in the medulla oblongata (84.38 p. c.), 
another proof of the superiority of this part of the nervous 
centre. Next comes the pons Yarolii (86.77), which has the 
very smallest amount of water in the adult. The white sub- 
stance of the large hemispheres contains most (89.93) in the 
infant, while it has less in the adult; and the gray substance 
of the infant has 87.76 percentage of water, while it contains 
a large percentage of it in the adult (without, however, ob- 
taining the same absolute percentage of the infant). In this 
respect, while the embryo (also the infant) is so much inferior 
to advanced age, it ranks equal to the very oldest age of the 
human species or the lower vertebrates. 
In the embryo and newly-born there is no or little differ- 
ence between gray and white substances. This difference is 21 
a condition sine qua non of the normal action of the brain 
in advanced age. 
In the infant the whole mass of the brain is soft, uniform, 
grayish, the ventricles smooth ; the convolutions are but few, 
and large. In the adult the differences of the brain-substance 
are better marked, the ventricles more elaborately formed, 
the convolutions more numerous and irregular. 
In the infant the peripheric nerves are larger in propor- 
tion than the nervous centres (with the exception of the sym- 
pathetic ganglia, -which are large), the spines more developed 
in proportion than the brain—therefore more reflex action, 
with powerful circulation, than intellectual work. 
The head of the new-born is one-fourth of the length, one- 
fifth of the weight, of the whole body. Its base is short, 
therefore the occipital bone horizontal; it is wide between its 
parietal tubera, therefore spherical, being low and narrow 
anteriorly. 
The cranial cavity of the new-born (482 cubic centimetres) 
amounts to one-fourth or one-third of that of the adult, and 
grows very rapidly (999 cubic centimetres in the second year). 
The growth, however, is not uniform. Originally the occipi- 
tal portion amounts to five per cent.—parietal 81.11, frontal 
13.89—of the whole mass. Of these the first grows very fast, 
the second decreases a little in the second year, and the third 
grows but little. 
The weight of the cerebellum in the infant (25 grammes, 
7 drachms) amounts to six and seven-tenths per cent, of the 
whole brain; in the adult 12 or 14 per cent. Look at the 
rapidity of the changes. Six and seven-tenths per cent, at 
birth, nine and one-tenth in two months, 12 or 13 at ten or 
fifteen years, 12 or 14 in the adult. 
The relations of the several parts of the infant and the 
adult brain are also instructive: 
Infant. 
Anterior lobe (60-70 grammes) = 1 of the adult. 
• Lateral (250 “ ) = i “ “ 
Cerebellum (25 “ ) = i “ “ 
Hemispheres (300 “ ) = “ “ 
All the parts of the body have their fastest growth within 
the first three years of life. 22 
Length of body at birth (according to Schadow), 18 inches 
(German, larger than English); at death, 66. Increase in the 
first year, 10 inches ; second, 4 ; third, 4 ; fourth, 3; fifth, 3 ; 
sixth, 2; seventh, eighth, ninth, tenth, each 1, etc. A certain 
retardation therefore with seven years. 
Proportion of upper portion of trunk (chest) to lower in 
the new-born = 1 : 2 ; in the adult, 1 : 1.618. This normal 
proportion is reached with the eighth year. 
Lumbar region grows principally up to the ninth year 
(then again between twelve and fifteen)—ought to be developed 
before the children are compelled to remain long in a sitting 
posture. Retardation of the growth of the lower extremity, 
as also the trunk, and the whole height, about the seventh or 
the ninth year. 
Relation of upper head (cranium) to lower (face) in the 
new-born = 1:1. In the adult = 1 : 1.618. This propor- 
tion is reached with the eighth year. 
Between the fifth and sixth years the base of the brain 
grows very rapidly; the frontal bone protrudes anteriorly and 
grows upward. The anterior portion grows considerably, but 
still the white substance and middle portion of brain are prev- 
alent. These are the organs for the receptive faculties and 
memory. About this time learning ought to commence in 
earnest. All the above figures point to the end of the seventh 
year as the period of beginning mental work. But the gray 
substance is also developing at that period. It ought to be 
influenced to a certain degree, like a young tree in the time of 
its growth, without, however, being strained. Many organs 
in the brain, many functions. Neglect none, exercise all 
gently. It is a mistake to exercise one faculty only. Our 
text-books, in the shape of catechisms, exercise the memory 
only, and thereby fatigue and exhaust. The compound exer- 
cise, consisting in walking, with its changes and cooperative 
action, is less fatiguing than standing on a single leg. Learn- 
ing by heart is not learning, and reciting is not thinking; just 
as little as deglutition is digestion. 
The younger the age in which children are sent to school, 
the more they are apt to suffer from school-diseases. Improp- 
er temperature, bad air, dust, contagion, insufficient respiratory movements, insufficient muscular action, compression of ab- 
dominal viscera (thereby nose-bleeding, headache), scoliosis. 
This is apt to commence very early, its causes being local; 
habit of improper posture, the effort to raise the right shoul- 
der, to hold the head to the left to follow the movements of 
the pen, the height and distance of the tables, the accumula- 
tion of clothing (in girls entering the benches) under the glu- 
teal region, the resting on one (mostly the left) synchondro- 
sis sacro-iliaca, etc. 
Besides, every organ which is over-exerted in its physiologi- 
cal function, especially when in the process of normal develop- 
ment, will soon exhibit the symptoms of pathological in place 
of physiological congestion. Epilepsy and St. Yitus’s dance 
are superinduced by over-exertion of the brain, as the latter 
is also liable to result in exhaustion. Frequently very prom- 
ising little children become dull and lazy; and other boys 
trained a few hours daily in an evening school will often out- 
do in a short time those who commenced their school drilling 
at an early age. Moreover, the time indicated above—seven 
or eight years—is just that in which a spontaneous love for 
more active work is generally developed. 
It is, further, the period when morbid tendencies diminish 
considerably. Contagious diseases of all sorts and tubercular 
meningitis are not so frequently observed after the seventh or 
eighth year. Of all the deaths taking place in New York City, 
29.63 per cent, fall within the tirst year, 10.03 the second, 
4.37 the third, 2.40 the fourth, 1.64 the fifth, 3.20 the sixth— 
thus 51.28 within the sixth year. The whole period-from the 
sixth to the eleventh year yields but 1.50 per cent. Thus the 
principal mortality has passed by at the time proposed (seven 
or eight years). It is a common experience that orphan asy- 
lums containing children from seven or eight to fifteen years 
have a low mortality, proving that this period of life yields 
less dangers, while it also exhibits a greater faculty and willing- 
ness to undergo mental work on the part of the children. 
Every organ, the brain like the others, must be sufficiently 
prepared, when it is expected to be capable of being trained. 
The age proposed above cannot be expected to be the 
exact one in every individual case. No rule will be valid al- ways. The state of health will sometimes be such as to pre- 
clude a child’s going to school at the age of seven or eight, or 
at any age. Contagious diseases, insufficient intellect, epi- 
lepsy, chorea, retarded growth without any apparent local 
trouble, acute or chronic organic diseases, deformities, and 
many other causes, may keep a child out of school, wfth or 
without the approval of parents, part of whom are just as apt 
to send their children to school from vanity as from anxiety 
to get them out of the way. 
REMARKS OF DR. J. C. PETERS. 
Dr. Peters said: 
I believe that there are about 250 public schools in this 
city, twenty-three hundred (2,300) teachers, and upward of 
one hundred thousand (100,000) scholars1—all now without 
proper sanitary and medical supervision. The bare statement 
of these facts is sufficient; they speak for themselves. It is a 
disgrace to the age, to the city, and to the persons who have 
brought about this condition of things. 
I am sure that any skilled medical sanitarian could dis- 
cover scores of sanitary defects in the management of our pub- 
lic schools. I infer that the teachers will always be glad to 
receive hints about the health of their scholars, and it is very 
necessary that they should have them. Yaccination is too trite 
a subject to be talked about now; but all those great conta- 
gious and infectious diseases which break out in large cities, are 
brought to public schools, there increase a hundred or a thou- 
sand-fold, and then are redistributed all over the city, require 
particular attention. Children who have had measles, scarlet 
fever, varioloid, chicken-pox, sinall-pox, whooping-cough, etc., 
are only too often allowed to go to school long before they are 
properly disinfected and purified, and while they are still capa- 
ble of giving the disease to others in every direction. I ear- 
nestly call particular attention to the fact that not only the 
clothing of such children should be properly aired or purified, 
but their whole persons should be thoroughly washed, soaped, 
and well scrubbed, especially their hair. Every crust or scab of 
small-pox, varioloid or chicken-pox, should be removed from 
1 The recently-annexed school districts not included. the beads of these children ; and every scale from the hair and 
persons of those who have had scarlet fever or measles, before 
they are allowed to rejoin their classes. The scurf and scales 
falling otf from the heads and persons of children lately recov- 
ered from scarlet fever and measles will float in the air, be 
inhaled by others, and assuredly cause the disease, unless the 
hair, head, and persons of these children have been thoroughly 
soaped and lathered, and wrashed with plain or carbolic soap. 
The expectoration of children with whooping-cough is infec- 
tious. The proper disinfection of school premises can only be 
supervised by a skillful medical man. Such instances could 
be extended ad infinitum. A hint is sufficient for the wise; 
for constant sources of disease must be arising among 100,000 
children which will assuredly react upon the whole commu- 
nity unless watched and properly met by competent medical 
skill. It is not only a crime but it is a gross inhumanity to 
leave so large a number of persons and so great a number of 
public buildings without proper sanitary supervision, and we 
cannot even afford to pity the presumption, which can only 
be born of ignorance too gross to be tolerated, which has pro- 
duced this state of things. 
In concluding the discussion, Dr. O’Sullivan, after express- 
ing his acknowledgments to the members of the Academy 
and the profession generally, for the interest they had taken in 
' the subject to which he had that evening the honor of calling 
their attention, said he would merely allude to a few points, 
in reference to which he was afraid he was not sufficiently ex- 
plicit in his paper. The infant-class rooms in primary schools 
and departments were as a rule excessively overcrowded, and 
in many instances largely in excess of the number allowed by 
the by-laws of the Board of Education. It was not an uncom- 
mon occurrence to find from one hundred and fifty to two 
hundred of these very young children in the gallery classes. 
As an instance of this excessive overcrowding, he stated that 
one of the primary departments had an averarge attendance 
of fifteen hundred. The middle rooms were so badly lighted 
that in cloudy weather the pupils could scarcely discern the 
figures on the black-board. As a measure of relief for these 
overcrowded class-rooms he suggested (in his report, Hovem- 26 
ber, 1872) that the lower classes, comprising the fifth and sixth 
grades, should be dismissed as soon after the morning session 
as the requirements of the present law on this subject would 
permit. This suggestion, if acted upon, would not materially 
interfere with the studies pursued in these classes, and could 
not fail to be beneficial to the health of the pupils. In warm 
weather during the noon recess, they are exposed to the in- 
tense heat of the sun, at the hottest hour of the day, and in 
the winter season they are exposed to catarrhal affections. 
He condemned in decided terms the basement class-rooms. 
In this connection the doctor referred to his annual report to 
the Department of Public Instruction, April, 1872, in which 
he says: “ In the basement class-rooms there is an insufficient 
supply of pure air and light. These rooms are situated in the 
immediate vicinity of the water-closets, being lighted from the 
yards, and are in other respects ill-suited for class purposes.” 
In certain school districts the condition of the school-houses 
was such as to indicate the necessity of extensive repair. Dr. 
O’Sullivan had made several reports on this subject, in which 
he called the attention of the Board of Education, urging the 
necessity of action in this matter. He had made, in the early 
part of this year, an inspection of all the schools under the 
jurisdiction of the Department of Public Instruction, and re- 
ported upon their condition—a synopsis of which report was 
under the consideration of the Committees on Course of Studies 
and Buildings at the time the late Board was abolished. It 
would take at the present time upward of half a million 
dollars to put those school-buildings in proper repair. Of 
course, the longer this matter is deferred the greater the ex- 
pense will be, not to speak of the injury to the health of the 
children which must necessarily follow from their present 
condition. He regretted to add that the present Board of Ed- 
ucation failed to apply for the necessary funds to make these 
improvements previous to the adjournment of the Legislature ; 
in consequence of which the sanitary defects in the school- 
buildings—as to ventilation, etc.—to which he alluded, would 
continue to exist, as no adequate measures could be taken 
during the ensuing vacation to remedy them. The proper 
sanitary supervision of the s'cliools had not been considered; 
in fact, this important subject had been entirely ignored. APPENDIX. 
abstract of this paper appeared in the New 
York School Journal. A proposition was also made 
to have it published in the Transactions of the New 
York Academy of Medicine. In deference to sug- 
gestions received from reliable sources, it was deemed 
best to place it before the public, with the remarks of 
the eminent physicians who took part in the discus- 
sion. The paper has been favorably received and 
commented upon, by distinguished members of educa- 
tional institutions. School-boards, in this and other 
States, have asked for copies. Encouraged by the 
opinions of the press, intimating a desire that the pub- 
lic should become better acquainted with the subject 
of which the paper treats, the author has concluded to 
publish it in pamphlet form. In his first Annual Re- 
port to the Board of Public Instruction on the sani- 
tary condition of the public schools of this city (which 
preceded the reports of the press, and the Board of 
Health), the author called attention to the unsanitary 
condition of the class-rooms, water-closets, etc., and 
made such suggestions as were deemed necessary to 
place those buildings in a proper sanitary condition 
(see Annual Report—minutes of the Board, for the 28 
year ending April 30, 1872). In a subsequent general 
report on this subject, an abstract of which appears 
in the Journal of the Board, January 15, 1873, special 
attention is called to the condition of the primary 
schools in certain districts, which were excessively 
overcrowded, the buildings and class-rooms being 
unsuitable for school purposes. It was recommended 
that the refusal of admission of new pupils, beyond 
the capacity of the class-rooms to accommodate them, 
should be enforced. The building of additional pri- 
mary schools, or of wings added to primary depart- 
ments, was also recommended. This would afford the 
needed relief, especially in the most populous districts. 
At a recent meeting of the present Board of Edu- 
cation, action was taken in this matter, in so far as sup- 
pressing some of these schools was concerned. The 
other portion of the recommendation, viz., the reduc- 
tion of the number of pupils in the class-rooms (which 
in many instances is largely in excess of the average 
allowed by the By-Laws of the Board of Education), 
has not yet been acted upon. Transferring these chil- 
dren to other schools may in some measure obviate 
the injurious effects of overcrowding, but it is obvious 
that it cannot materially benefit the health of the pu- 
pils unless the numbers are reduced to the required 
standard. This important sanitary measure will, it is 
hoped, receive due attention from the school authori- 
ties, when they come to consider the various methods 
of improving the ventilation of school-buildings which 
are now put forward. With these measures enforced, 
and medical inspection thoroughly and systematically 
made, the health of the children will be properly pro- 
tected. This latter requirement is of the greatest im- 
portance, as the other improvements contemplated are 29 
but adjuncts to this end. The results attending the 
medical inspection of the schools prove the necessity 
of the office, and place beyond question the propriety 
of its institution. It was a reform in school manage- 
ment which their hygienic surroundings demanded. 
This deduction is sustained by public opinion, as ex- 
pressed by the press, and leading medical journals. 
No stronger evidence need be adduced as confirming 
these views than a brief extract from a letter from 
one of the most illustrious observers of our school-sys- 
tem, the late James W. Gerard, who kindly sent to 
the author of the paper a letter recommending the 
present Board of Education to continue the office of 
Sanitary Superintendent. After a careful review of 
the results of that office, Mr. Gerard says: 
“ The second object in establishing it ” (viz., the sani- 
tary superintendency), “ the prevention and check of 
pestilential diseases in the schools, I am satisfied that it 
has been essential to the health and lives of the pupils 
in small-pox, which, when it breaks out, sweeps the 
schools, from the neglect of thousands of parents in not 
having their children vaccinated. Look how this pest 
has broken out in the schools since the organization of 
the department, and put the question to yourselves, but 
for it, how many children who are now well and hearty 
would have been dead and buried, victims of the dis- 
ease ! I have examined into the vaccination by Dr. 
O’Sullivan, since he has been in office ; and by his un- 
tiring energy and assiduity he has more or less vacci- 
nated the schools in the city, not merely by thousands, 
but by tens of thousands. Suppose the pest should 
break out again to-morrow (and it is liable to reap- 
pear every day), what would the Board do ? Would 
it let it run riot without any attempt to stop it? 30 
What would public opinion say in that case ? Would 
not the Board be compelled by this opinion to reverse 
their wheel of action and restore it ? ” 
The State law of 1860 in reference to the subject 
of vaccination, chapter 438, section 1, directs that 
the trustees of the several common - school districts 
in this State, and the proper local boards of com- 
mon-school government in the several cities of the 
State, shall exclude from the benefits of the common 
schools any child or person who has not been vacci- 
nated, and until such time when said child or person 
shall be vaccinated. This law further requires the 
school boards in the various districts of the State to 
include in their annual report the number in their 
several districts, between the ages of five and twenty- 
one, who are vaccinated, and the number unvacci- 
nated. This law further authorizes the school boards 
in the various districts of the State to employ a 
competent physician to perform this duty; the ex- 
penses incurred by the act shall be included and col- 
lected in the annual tax bill of the town, village, or 
city, as may be proper according to law. The Board 
of Education of the city of Elmira, in this State, has 
complied with the requirements of the law, and the 
success which has attended the action of the board re- 
flects the highest credit on their intelligence and effi- 
ciency. Medical inspection of the schools under their 
charge has received due attention by the appointment 
of a sanitary superintendent. The duties of this offi- 
cer are defined as follows, Article IV., Section 1, By- 
laws of the Board: “ The Sanitary Superintendent 
of the Board shall have authority to visit the schools 
whenever he shall deem it necessary, for the purpose 
of examining what pupils have not been vaccinated, 31 
and no pupil shall be allowed in the public schools 
who has not been properly vaccinated. 
“ Sec. 2. Certificates of vaccination given by the 
Sanitary Superintendent or by any reputable physi- 
cian, approved and indorsed by the Sanitary Superin- 
tendent, shall be kept and filed by the principal of 
the school at which they are received, to be given 
back on the transfer of the pupil to another school, or 
on his or her removal from the city. 
“ Sec. 3. It shall be the duty of the principal of 
the school to enter the word vaccinated in the school 
register opposite the name of any pupil producing a 
proper certificate of vaccination; and such entries, 
with the certificates on file, shall be deemed sufficient 
proof that the pupil has complied with the require- 
ments of the law of this State, in respect to vaccina- 
tion.” 
From the report of Dr. Frank B. Abbott, the Sani- 
tary Superintendent, the following abstract is given: 
“ Of the beneficial results of a law providing for en- 
forced vaccination in the schools, no liberal-minded per- 
son can have any doubt. I think we may attribute 
our good fortune in escaping an epidemic of small-pox 
in the city, in a large measure, to the thorough manner 
in which vaccination has been insisted upon among 
the children in all the schools. What else could have 
protected us when neighboring towns suffered so 
severely from the ravages of this disease ? But for 
this necessary and humane observance of law, one of 
the schools would have been the means of communi- 
cating and spreading the contagion of small-pox on 
one occasion, wdien two classes were exposed by the 
presence of pupils coming down wTith varioloid, who 
were permitted by their ignorant parents to be in daily attendance, notwithstanding the fact that one 
of the family, with whom they were forced by circum- 
stances to be in constant contact at home, was lying 
sick with the worst form of the disease, which ulti- 
mately proved fatal.” 
When we contrast this practice with that pursued 
in this city, that of requiring the evidence of vaccina- 
tion previous to the admission of pupils, it must be 
clear to any reflecting mind that in this respect the 
statutory requirements are not properly complied with; 
and the data furnished insufficient and unsatisfactory. 
If those measures, in compliance with the law, can be 
so succesfully enforced in the city of Elmira, whose 
schools have an average daily attendance of 2,331 pu- 
pils, and deemed indispensably necessary for the pro- 
tection of their health, how much more necessary the 
fulfillment of the law must be in the direction of the 
schools of this city, with an average attendance of up- 
ward of 100,000 pupils! In the supervision of their 
studies, there are employed, besides the City Super- 
intendent, six assistant superintendents; and it is pro- 
posed to add to this number, as, it is alleged, the in- 
creased area of the city requires one additional assist- 
ant. If it be necessary that additional superintendents 
should be appointed (and no one will doubt it), 
in order that the mental training of the pupils be 
kept up to the required standard, is it not also neces- 
sary and reasonable that the physical condition of the 
pupils should receive some attention from the Board ? 
There should be one of those superintendents charged 
with medical supervision. No mere plea of economy 
will be considered a sufficient excuse in ignoring this 
requirement, as the health and usefulness of a large 
portion of the future generation of this city depend 
upon this action. With a system of education so im- 33 
mense as ours, which will this year require an expen- 
diture of $4,000,000 (four million dollars), the plea 
of economy will not be accepted as sufficient by the 
public. The duty of the school authorities is plain. 
They are bound legally and morally, as the conser- 
vators of the health of the children confided to their 
care during school-hours, to place around them such 
safeguards that their physical growth shall keep pace, 
with their mental. 
The question will perhaps be raised by some well- 
meaning persons, whether the sanitary inspection of 
the schools does not come under the jurisdiction of the 
Board of Health. It is true that the latter department, 
on extraordinary occasions, may, for the protection of 
public health, enter any public or private building, 
and take such precautions as may be deemed necessary. 
The special sphere, however, of the Health Board is 
the correction of flagrant violations of the sanitary 
laws, the stamping out of contagious diseases in such 
centres of their propagation as market-places, slaughter- 
houses, and the immense tenement-house population, 
which are always fruitful sources of disease. In this 
sphere of its duty it has ample work to do, which will 
require all its resources and energy to accomplish, 
without interfering with the internal affairs of other 
boards who are obligated by law to perform this duty. 
The Board of Health already, in the performance of 
its arduous duties, has rendered valuable service to 
the inhabitants of the city, in arresting the spread of 
epidemic diseases; and also in the assistance rendered 
by them during the recent epidemic of small-pox. The 
success attending the result of this work is, that it was 
the largest and most successful school vaccination that 
had taken place in this city. This success was mainly 
due to the harmonious and conjoint action of both the 34 
Boards of Education and Health—the medical officer 
of the former Board preparing the way by visiting all 
the schools of the city, and giving it plainly to be un- 
derstood that no child should be vaccinated without 
its parents’ consent. The vaccination was performed 
with but very little interruption of class-exercises. 
Precautions were also taken to have the children resid- 
ing in or contiguous to the dwelling of a person having 
small-pox dismissed from the school until such time as 
it might be safe to readmit them. The authority by 
which these regulations were enforced is as follows: 
“ To the Trustees and Principals of Public Schools. 
“ In view of the alarming progress which this disease (small- 
pox) has lately made, though now on the decrease, it is sug- 
gested that you give these precautions jour most earnest con- 
sideration, and afford every facility in your power to the efforts 
of the Yisiting Physician of the Board, Dr. O’Sullivan, acting 
under its authority, and to the sanitary officers of the Board 
of Health, to have the directions here communicated thor- 
oughly complied with. 
Yery respectfully, 
Bernard Smyth, 
L. D. Kiernan, President. 
Clerk of the Board of Education. 
In attempting this work on previous occasions, the 
Health Board met with a good deal of annoyance and 
opposition from the local Trustee Boards. The action 
of the Central Board of Education, in the vaccination 
referred to, obviated this difficulty by the authority 
invested in its sanitary officer, which tended to remove 
all difficulties; and this harmonized the action of both 
Boards. 
On the question of school hygiene, I would call 
attention to the report on physical education found in 
the London Journal of the Society of Arts, for July 
26th, 1872. I extract the following: 35 
“ Sanitary Results.—It lias been shown as respects the 
common schools, where children are crowded together in ill- 
ventilated class-rooms, they are liable to become the common 
centres of children’s epidemics. The old workhouse schools 
were subject to murderous epidemics, but now by the applica- 
tion of rudimentary sanitary science they are made normal 
examples of what may be done by it. Of this, one of the 
schools, whence the children were sent to the first review, 
may be cited as an example: Some years ago the death- 
rate was ten and eleven per one thousand. The drainage and 
ventilation were improved and it was brought down to about 
eight in one thousand. Next, more complete personal ablu- 
tion and general cleanliness were established, and the death- 
rate was reduced to about three in one thousand, or less than 
one-third of the death-rate prevalent among children of the 
middle and well-to-do classes. 
“ With such a general death-rate producible by sanitary 
science there would be upward of ten thousand children saved 
annually to the metropolis; without such sanitary precau- 
tions, new schools may be only extended centres of children’s 
epidemics.” 
As to the necessity of medical supervision of the 
schools, it may not be out of place to give the testi- 
mony of an eminent physician holding the highest 
rank in the medical profession in the State. Prof. C. 
R. Agnew, in his annual address before the Medical 
Society of the State of New York at the meeting 
in Albany, February, 1873, said, in reference to the 
report of the author to the Board of Education on 
the sanitary condition of schools for the year ending 
April, 1872: 
“ Let us not content ourselves with hoping merely that 
the courteous action of the Board which ordered his” (the 
Sanitary Superintendent’s) “ report in full upon the minutes 
and on file, would be followed up by intelligent action, but 
let us see to it that the hands of our professional brother, and 
all others who like him are at work, be strengthened, and 36 
that we are behind them to sustain them with the full weight 
of our united intelligent influence, and to make action cer- 
tain.” 
At the first regular meeting of the new Board of 
Education (April 12, 1873), the following communi- 
cation was read: 
New York, April 1, lSYS. 
To the Honorable the Board of Education. 
Gentlemen: In view of the interest which, as medical 
men, we take in the sanitary condition of the schools, and of 
the public sentiment lately manifested with regard to the 
health and well-being of the pupils, we venture to commend 
this matter to your attention. We would also certify to the 
eminent fitness of Dr. R. J. O’Sullivan for the position which 
he now holds as Sanitary Superintendent. Dr. O’Sullivan 
is a physician in good standing in the medical profession. 
For several years he has given close attention to sanitary 
affairs, as relating to the schools, and from his studies and 
experience we deem him to be peculiarly fitted for the posi- 
tion which he has for some time held under the Board of 
Education. 
Respectfully submitted: 
Ellsworth Eliot, M. D., 
Pres. Med. Soc. of the County of Hew YorJc. 
Austin Flint, M. D., 
Pres. Academy of Medicine. 
John C. Peters, M. D., 
Pres, of Medical Library and Journal Asso- 
ciation of Hew York. 
C. R. Agnew, M. D., 
Ex-Pres. Med. Soc. State of Hew York. 
Clark Bell, M. D., 
Pres. Medico-Legal Society. 
E. R. Peaslee, M. D. 
E. Krackowizer, M. D. 
Fordyce Barker, M. D. 
A. Jacobi, M. D. 
James Anderson, M. D. 
Wm. H. Van Buren, M. D. 
James R. Wood, M. D. 37 
Commenting on tlie paper on School Hygiene, the 
Medical Record (September 15, 1873) says : 
“We have already seen what medical supervision has done 
toward preventing the spread of small-pox—of forty thousand 
pupils vaccinated under the supervision of Dr. O’Sullivan 
during a recent epidemic, every one escaped contagion. It 
may be urged that the Board of Health can look after such 
matters; but, in view of the immense amount of special work 
to be performed, this is absolutely impossible unless special 
medical officers be appointed for that purpose. But we care 
not how the inspectors are appointed, so long as competent 
men are chosen to perform the duties. 
“ As the case now stands, there is not only no medical in- 
spection of our public schools, but, worse than this, medical 
inspection having been once instituted, is boldly and defiant- 
ly abolished. The duty of medical men in this matter is plain 
enough, and looks in one of the directions of good which they 
can accomplish as educators of the people and as creators of 
opinion upon all matters of hygiene. We appeal to the pro- 
fession, and urge them to take this important subject under 
consideration, and use every endeavor to educate the people 
up to the point of appreciating, of demanding the necessary 
reforms. We are pleased to see so much attention given to 
the subject, and such efforts made in the direction of the 
necessary influence to be used, that in the discussion of the 
paper we can find such gentlemen as Agnew, Jacobi, O’Sulli- 
van, and Peters, to speak so earnestly and so much to the 
point upon the question at issue. Let the profession every- 
where follow their lead, and if they act with determination 
they can create such a sentiment among their respective com- 
munities as no school board shall dare, even for political rea- 
sons, to disrespect.” 
The following comments on the action of the 
Board of Education, and the consequences following 
the suppression of the sanitary superintendency, ap- 
peared in the editorial columns of the Evening Post: 38 
HEALTH m THE PUBLIC SCHOOLS. 
“ It is not generally known that there are no provisions now 
in force for the sanitary and medical inspection of the public 
schools of this city. There are, on Manhattan Island, about 
two hundred and fifty public schools, containing nearly twenty- 
five hundred teachers and other officers, and more than one 
hundred thousand scholars. Many—indeed the most—of 
these scholars are the children of parents whose ignorance pre- 
vents them from fully understanding the unwholesome sani- 
tary conditions under which their poverty forces them to 
maintain their households, while the scholars themselves are 
of that age most subject, not only to the common diseases of 
childhood, but to any virulent and contagious disease which 
may be prevailing in the community. 
“ It would be difficult to find a reason for this neglect to 
take proper precautions against the appearance and spread of 
disease among our public - school children, but the various 
steps by which this result has been reached are known to us. 
On the 2d day of December, 1870, the Board of Education 
appointed a visiting physician of public schools. This officer 
entered upon the duties of his office on the 1st day of January, 
1871. On the 2d day of October, 1872, a resolution' urging 
the appointment of a sanitary superintendent of the public 
schools was brought before the Board of Education, by which 
it was referred to the Committee on By-Laws. A favorable re- 
port was received from the committee at the meeting of the 
Board on the 30th day of October, whereupon the resolution 
was adopted, and the office at once filled. During the follow- 
ing winter, the State Legislature made a new charter for the 
city, by which the members of the Board of Education were 
changed throughout. At the meeting which the new Board 
held on the 30th of April, 1873, Commissioner Halsted pre- 
sented a report in respect to a proposal to abolish the office of 
‘ Physician to the Board of Education, and Sanitary Superin- 
tendent,’ and also the following resolution : 
“ ‘ Resolved, That the office of Physician to the Board of 
Education be, and the same is hereby abolished on and after 
this date, and the duties heretofore performed by said officer 39 
are and shall be lodged with the City Superintendent, where, 
by the statutes, they belong.’ 
“ This resolution was amended, on motion of Commissioner 
Beardslee, by striking out all after the word ‘ date,’ and in 
this amended form it was adopted without a dissenting vote. 
Since the 30th day of April, therefore, our public schools 
have been absolutely without any medical care whatever. 
“ As is suggested above, we are at a loss to account for this 
action of the Board of Education. Undoubtedly, the mem- 
bers acted on what seemed to themselves to be good and suf- 
ficient reasons. But we cannot go further than to give them 
credit for good intentions. They have made a great mistake, 
and, the further any one looks into the subject, the more ap- 
parent will this become. 
“ At a recent meeting of the New York Academy of Medi- 
cine, a paper treating of the care of children in public schools 
was read by Dr. O’Sullivan, and afterward commented on by 
Drs. Agnew, J. C. Peters, and Jacobi. The paper was a sin- 
gularly able one, and the debate wdiicli followed very interest- 
ing. Two points were brought out with great clearness. 
The disease of near-sightedness is becoming more common 
in this country every year, in consequence of our badly-built, 
badly-lighted, and badly-managed public-school houses. The 
same thing is true of England, and, in a more marked degree, 
of Germany. What is worse, however, is the fact, according 
to Dr. Agnew, that when a child becomes near-sighted—that 
is, is not so naturally—the disease ‘ is almost invariably pro- 
gressive, and, sooner or later, complicated by organic changes, 
threatens blindness.’ The other point relates to contagious 
diseases, whose existence and spread among school - children 
can be prevented or stopped only by a weekly medical inspec- 
tion of the scholars. Thus out of forty thousand school-chil- 
dren vaccinated last year, Dr. O’Sullivan says that not one 
was attacked by the small-pox. So other special diseases 
would be prevented by a system of medical supervision, 
which, without such supervision, either through carelessness 
or ignorance, enter our schools and disorganize them, if they 
do not decimate them. 
“ We carmot speak of the overcrowding and bad ventilation of rooms, the long hours of confinement, and other evils, 
which will appear in the best system under the most careful 
but unprofessional management. These things are at once rec- 
ognized, and may be remedied by a skillful physician. He 
is a check upon bad teachers, and an aid to good teachers. 
He is the terror of architects who undertake to build new 
school-buildings. He is a most valuable and necessary public 
officer, and it is not only disgraceful but dangerous that an at- 
tempt should be made in the city of Hew York to manage tjie 
public schools without his assistance.”