Talks on health for Georgia teachers; issued from the State department of education, Atlanta, Ga., March 1, 1911

TALKS ON HEALTH
FOR
Georgia Teachers
Issued from the State Department of Education Atlanta, Ga., March 1, 1911 M. L. BRITTAIN
State School Commissioner

FOREWORD.
With the exception of the first and last topics, this Bulletin has been prepared at my request by Dr. A. G. Fort, with the approval of the Secretary of the State Board of Health. Our greatest thinkers agree with Herbert Spencer that these subjects concerning healthful living are of vast importance in our educational work. The prevention of disease and the preservation of health through the dissemination of knowledge are among our most important civic obligations. To gain all knowledge will be of litle worth if the bodies of our children are weakened through ignorance of the simple laws of sanitation.
Teachers and school officials are urged to give careful attention to the suggestions made in this pamphlet. The substance of the articles should be presented orally to the pupils in such language as all can understand. Secure the help of a good physician and occasionally invite the parents and friends to take part in the exercises.
Some of the topics are necessarily disagreeable. It would he much more pleasant to ask for exercises on "the Good, the True, and the Beautiful" or some other <:esthetic subject, but no one acquainted with the facts can honestly disguise to himself the real need for the practical. instruction given in the following pages. Please do not neglect these distasteful lessons. The Augean task must not have appealed to the classic taste of the old Greek, but this did not deter him from his disagreeable duty. I confidently appeal to the civic pride and patriotism of every teacher to aid in this important work. By tactful management, these talks can be properly presented. I t is a matter of common sense as well as civilization, that help and instruction be given on subjects so vitally concerning the health and happiness of all.
SiMcerely yours, M. L. BRITTAIN,
State School Commissioner.
Atlanta, Georgia, March 1, 1911.

CHAPTER 1.
THIS VALUE OF HEALTH.
The nation's greatest asset is its people. This asset is valuable only in proportion to the physical, mental and moral development of each individual. With health, the limit of man's ability is almost boundless, but when his powers are dwarfed by disease he can hope for little and even this is rarely attained. Health is necessary for the enjoyment of life. It is necessary for the application of education to man's work. "\!Vhat shall it profit a nation if through education it gain all power, intellectual and spiritual, but through disease lose its physical vigor, and its body, by which alone it can act upon the world?"
Health is wealth, and on the value of health depends the value of man. Six hundred thousand Americans die every year from preventable disease, and three million are now sick from ignorance or inattention to the laws of sanitation. It is stated on good authority that the value of an average American is $2,900. If we accept this as true, our loss from preventable death is $1,7JO,000,000.00 annually. Add to this the $1,000,000,000 which political economists estimate as the yearly amount of wasted productive energy caused by preventable disease, to our country. Add to this the expense to the people caused by typhoid fever, malaria, measles, diphtheria, dysenteries, pellagra, hook-worm and summer diarrhceas. Add the anxiety of fond parents and loving friends, and the heartaches of millions from the loss of loved ones. Add all of these and then and not till then can we have the proper idea of the value of health.
It will surprise many to know that leading magazines have repeatedly made the statement that the city has become actually more sanitary than the cOllnlry. ;\ p,'c'rninent health commissioner of a southern 3tate wntes in the journal of the American Medical Association 111<1t the changes for the better in the hygiene of the cities has placed them in advance of
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the country in this particular. \Vhether this statement is corrector not, certainly the organization of health departments, and the supervision of water and milk supplies have been of immense advantage in promoting the healthfulness of city life.
While this is true of the city, the country districts and many small towns as a rule, have had neither effiCient organization nor health supervision. The reporting to the proper health authorities of even the most dangerous of contagious diseases in very few communities has had adequate attention.
The reason assigned for this state of things is because there is a greater survival of the individualistic idea of life in the country than in the city. In thickly populated communities, no man lives unto himself alone. Government is at the elbow of every citizen, while it touches the man in the country to a limited degree only. The very fact that health departments are so obviously necessary in centers of population, generally convinces the people of such communities of the importance of sanitary measures. The outskirts of many of our cities, however, are in many instances, sadly in need of sanitary supervision.
Naturally the country is more healthful, but this is not the case where the obvious laws of sanitation are neglected. If wells are carelessly dug, or if they are built without protection against drainage from the stable and out-houses, it is practically impossible to avoid illness. The outdoor life of the farmer is a most efficient aid in repelling disease of all kinds, yet even under these favorable circumstances, the body will soon suffer without actual knowledge concerning food and cooking, as well as sanitary living.
The truth is that all of us, whether living in the city or country, should pay attention to the laws of health, and learn everything that will enable us to live happier and more useful lives.
If every child in the state should sign the resolutions below, and keep them, it would mean much for the welfare and happiness of our people. They are adapted from the Student's Health Creed, and contain material for many health talks:
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MY HEALTH CREED. I believe my body and good health are sacred. If I am sick, it will very probably be because I have violated some one or more of nature's laws. I will study the laws of health and will obey them for my own sake. I will not wet my fingers in my mouth when turning the leaves of books. I will not put pencils in my mouth nor wet them with my lips. I will not put pins or money in my mouth. I will use my mouth for eating good, plain food, drinking pure water and milk, and for saying good and kind words. I will always chew my food thoroughly, and never drink whiskey or wine. I will not cough or sneeze without turning my face or holding a handkerchief before my mouth. Polite people never cough in public if they can prevent it. I will keep my face, hands, and finger nails as clean as possible. I will not spit on floors, stairways, or sidewalks, and will try not to spit at all; ladies and gentlemen try to avoid this bad habit. I will wash my mouth every morning on getting up and at night on going to bed, and will use a tooth brush if I can get one. I will be clean in body, clean in mind, and avoid all habits that may give offense to others. I will get all the fresh air I can and will open wide my windows when I go to bed.
Name of Student.
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CHAPTER II.
EYES.
Only a few of the diseases of the eye may be discussed in the space allowed here:
1. Those diseases which are communicable. 2. Those diseases which have directly or indirectly to do with the physical and mental development of the child, such as near-sightedness, far-sightedness, and irregularity in the contour of the cornea or the part of the eye through which light enters. It is well for us to know that simple conjunctivitis, or ordinary sore eyes, is a germ disease and is communicable. Usually both eyes are affected. It is more common in the spring and summer and is quite often epidemic. The infection is sometimes carried by means of towels, handkerchiefs, etc., especially in schools, hotels, and hospitals. In about 36 hours after the eyes become infected, they begin to sting and gradually redden. The lids are often glu2; 1 together from the discharge. Another form of sore eyes is what is commonly known as "granulated eye-lids," resembling, in a degree, a more severe disease called "trachoma," which is practically unknown in our State. With this infection we have inflamed eyelids, with small elevations on them. This condition is said to be slightly communicable. It is considered a splendid index to the general physical development of a child. Attention should be called also to the very severe and dangerous condition known as specific conjunctivitis. Thls runs a rapid course and eyesight is often lost. A large per cent of blindness from childhood is caused from this form of sore eyes. A young man, of splendid parentage, and of high educational attainments, was rendered practically helpless by this disease probably contracted from a towel on a train or
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steamship. So severe was the infection that his eyesight was completely destroyed in a few days. A few words of warning might have prevented this calamity.
To the defects of vision are due much of the mental apathy of the unfortunate little ones suffering from troubles of this kind.
By near-sightedness it is meant that the eyeball is too long. This condition is frquently acq..lired through careiess habits rather than inherited. The child cat: sec but poorly at a distance, and must hold a book very close to his eyes in order to read.
By far-sightedness, we mean that the eyeball is too short, a.nd objects have to be held at a distance in order to be properly seen.
By astigmatism, we t'":erLn th~lt the cornea cloes not howe the proper uniform convexity. With an eye like this, we see distinctly in a straight line only and the letters like a, 0, and c, cannot always be distinguished. Children suffering from these defects strain the muscles of their eyes in the effort to see. The far-sighted boy can learn readily from explanation given on the blackboard. The near-sighted boy is backward when taught by object lessons and illustrations. The astigmatic child ~s a rule reads poorly.
The straiti. occasioned by the constant effort of these children to properly focus their eyes upon objects, causes headache, indigestion, and various nervous disorders. They belong to the class who grasp every opportunity for staying at home and are usually the first to quit school. To none does medical attention offer a brighter future than to those suffering from these defects of vision. Many a child's whole life is blighted and his opportunities for obtaining an education lost from lack of glasses properly fitted.
Herewith is given the Snelling Test Sheet, which is a recognized standard. Directions for its use are as follows:
Fasten the sheet to the wall so that the letters will be 011 a level with the eyes of the child seated 20 feet distant. The light should bp. ~ood but should not shine in the child's face
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or on the chart. Test each eye separately and then both eyes together. Cover one eye with a card and let the .child read, from left to right, the smallest letters that can be clearly seen. Then cover the other eye and have him read from right to left. The number over each line of the test letters shows the distance at which a normal eye should read them. Then test them, using both eyes as before. If the defect in vision is considerable, advise the parent to consult a competent eye specialist. Of course the test could not be made with children unable to read.
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CHAPTER .III.
EARS.
In the discussion of the ear, it is well to saysomethirtg cbricerning its anatomy and physiology, in order to properly nttdetstartd the effect of various conditions on hearing.. The otlterear is the part we see. The middle ear is like a closed box. The outer side of it is covered by the drum-membra.ne, a glistening tissue which can be seen by looking into the ear from the outside. To this is attached one of the three small bones of the ear. VVithin this enclosed chamber is air, carried through a little canal known as the "eustachian tube," which extends from the back of the nose into the middle ear. Sound is transmitted by sound waves, and the motion of these causes a vibration of the drum membrane, and in turn, this vibration is transmitted by the chain of small bones and the air in this enclosed box to the inner wall. From here, they are carried through the nerves to the center of hearing in the brain. Any disease of the nose or throat which might cause a closing of the eustachian tubes interferes with hearing; first from a lack of equalization of air in the middle ear, and second, by forcing or allowing pus or germs to be forced into it through this tube; this causes inflammation, which may produce perforation of the drum, a growing together of the small bones, or an inj ury to the ends of nerve fibers. Any or all of these conditions will interfere with hearing. Lack of attention or apparent indifference in many children is due to a defect of this kind, and many so-called dull children are mentally bright, but are more or less deaf.
In this connection, careful attention should be paid to adenoids, because they are the most prolific cause of deafness. They are lymphoid growths just above and behind the palate. A child suffering from adenoids is unable to properly breathe through the nose, and mouth-breathing with noisy respiration, snoring, and lack of resonance of the voice and an appearance of listlessness and indifference are prominent symptoms.
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Such children are absent-minded, and have the appearance of being inattentive, which may be due to mental dullness, impaired hearing, or both. These defects should receive attention for the following reasons, which are given by good authorities:
1st. The ever threatening danger of ear complications, inflammation of the middle ear,-deafness, mastoiditis, and meningitis.
2nd. The greater liability to serious infectious diseasesespecially scarlet fever and diphtheria.
3rd. The influence of the obstruction on the general health, mental development and the formation of the face. results which may remain permanently if the glands themselves undergo atrophy.
A simple test for hearing is given in order that the teacher may ascertain the acuteness of this faculty in each child, and thereby inform the parent and himself of any defect. The majority of cases of partial deafness and other diseases of the ear found among children are caused by some slight affection of ~he throat or nose, and may be easily cured if treatment is not delayed too long. A simple metho(~ ::lken from the directions for testing hearing, prepared by the State Board of Health of Massachusetts is as follows: "The examination should be conducted in a room not less than 25 or 30 feet long and in as quiet a place as possible. The floor should be marked off with parallel lines, one foot apart. The child should stand in the first space.
The examination should be made with the words whispered or spoken in a low tone of voice; the child should repeat what he hears, and the distance at which words can be heard distinctly should be noted.
The examiner should attempt to form standards by testting persons of normal hearing at normal distances. In a still room, the standard whisper should be heard easily at 25 feet; the whisper of a low voice can be hard from 35 to 40 feet, and of a loud voice from 45 to 60 feet. The two ears should be tested separately.
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CHAPTER IV.
NOSE. The normal nose is such that the inhaled air IS properly warmed before reaching the lung. Any impairment tends to mouth-breathing and improper heating of air. It is a fact that mouth-breathers are more subject to diseases of the nasal tract, such as "colds" and "catarrh" than are those who breathe normally. We have been led to believe that colds are trivial troubles but as we watch their deleterious effects when neglected, we shall be impressed with the fact that they frequently lead to some serious malady. Colds are caused from germs and are contagious. No place is better suited than the schoolroom for spreading these troubles. Draughts and poor ventilation by reducing the resistant power of the child make infection easy. How are we to prevent taking cold? 1st. By proper dressing; according to many authorities wool next to the skin is preferable to cotton or linen, as it permits rapid evaporation of perspiration. 2nd. Overshoes should be used to prevent the feet from becoming wet, but should never be worn in the house. 3rd. Sleep in well ventilated rooms; the practice of sleeping out-of-doors is a good one when climate will permit. 4th. Avoid sudden changes in temperature and never allow yourself to become suddenly chilled. 5th. Eat wholesome food, and not too much of it. 6th. Keep yourself in good physical condition. Small tumors called polypi occasionally fill the nasal passages, and when found, should be promptly and carefully removed by a competent physician. Mucus and crusts often obstruct the nose; under such circumstances a nasal douche of warm salt water is serviceable.
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CHAPTER V.

I

,. . .

MOUTH.

The mouth should be used for food, drink and speech, but is not a proper receptacle for pencils, paper, or tobacco.
Food is necessary for our maintenance. The value of it is dependent upon its food value and proper assimilation. Thorough mastication or grinding by the teeth is essential to normal digestion, and to properly masticate our food we must keep our teeth or grinders in first class condition. It would seem unnecessary to call attention to the necessity for keeping the teeth clean, but the examination of many children proves the fact. Decayed teeth cause offensive breath. They pre~ vent proper mastication of food, and therefore impair digestion. The statement that you should put nothing in your mouth except "food, drink, and toothbrush," means a great deal, and if observed, would, prevent much suffering.
The following catechism taken from Civics and Health by Allen is instructive:
Q. What are the teeth for? A. To masticate food: that is, grind it into fine particles. mix it with saliva, and so begin its digestion; also to aid in speaking and singing. Q. How long should they last? A. To the very end of life. Q. How do we lose them? A. By decay, by loosening, and by accident. Q. What causes teeth to decay? A. Particles of food decaying in contact with them. Q. Where does food lodge? A. All along the edges of the gums, in the spaces between the teeth, and in the crevices of their grinding surfaces. Q. Can we prevent this loss? A. Yes, to a large extent. Q. How can we do it? A. By using the teeth properly and by keeping them clean and the gums healthy.

Q. What does using them properly mean? A. 1. Using sufficient hard or fibrous food to give the teeth and gums full exercise. 2. Taking time enough to masticate food thoroughly before swallowing. Q. How often should teeth be cleaned? A. As often as they are used. Q. When should they be cleaned? A. Immediately after the morning and noonday meals, and before going to bed. Q. By what means should they be cleaned? A. A moderately stiff brush, water, and floss silk are the best possible materials for this purpose. Q. Hovv should these be used? A. The brush should be first used in a general way, high up on the gums lengthwise of the jaws, to remove large particles and stimulate the gums; then the brush and the teeth should be carefully rinsed with water; the brush should next be used with a rolling or circular motion, so that the bristles will follow the lines of all the grooves and spaces in which the particles of food have lodged, and so brush them out. Then again the mouth should be rinsed with water. Q. Should the gums be brushed? A. ,Yes, moderate friction helps to keep them healthy. Q. How can the spaces between the teeth be reached? A. By dental flo~s silk passed between the teeth, drawn carefully back against the side of each tooth in turn and drawn out towards the grinding end of the teeth, and this repeated several times in each space.
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CHAPTER VI. COMMUNICABLE DISEASES: A communicable disease is one that is carried from the sick to the well. Weare living in a new age, one of progressive enlightenment. In days gone by, when population was less dense, communicable diseases were not so much considered in public health matters. Now, when no man lives to himself, things are different. Formerly, time and attention were given to protection against attacks of savages, wild beasts and vandals. Cooperation in this line was easily secured. Disease was looked upon as a necessity. Modern science has proven that many diseases are preventable, and the great victories of peace in ridding Cuba of yellow fever, and making the Canal Zone as healthful as any of our modern cities-and more so than most of them-marks an epoch in our 'forward movement. The discovery of the cause of disease enables us to prevent it in a large measure: Ignorance alone is responsible for the untimely death of hundreds of thousands of Americans annually. In no place can facts be better taught children and the people, generally, than by the instructors in the school room, and no field is broader, and no path leads to a more praiseworthy goal than that of teaching the people how to live in order that they may be free from disease, and attain as near as possible to physical and mental perfection. Not all diseases which are communicable can be discussed by reason of lack of space, but the most common, and those which have principally to do with school children and their development are here considered.
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CHAPTER VII.
1 . -T U B E R C U L O S I S .
Of all the enemies of mankind, tuberculosis, in its various forms takes the first place. This affliction may occur in almost every part of the body and produce disease in every organ. Preeminent among these is the terrible malady known as consumption, which is tuberculosis of the lungs. As a result of the labors of thousands of patient, self-sacrificing investigators, the peculiarities of this malady are fairly well understood, and if we were to apply the knowledge which we now possess, in our attempts to free ourselves from its ravages, there is no question but that within a comparatively short time the disease would practically cease to exist.
1st. CHARACTER OF THE DISEASE:-Tuberculosis is produced by a germ known as the bacillus tuberculosis. This germ occurs in man and is also widely distributed among the lower animals.
2nd. COURsE OF THE DISEASE :-As it is from tuberculosis of the lungs or consumption that the contagion is generally spread, and as this is the usual form of the disease, a brief description of it follows:
Tuberculosis of the lungs generally comes on insidiously, there being usually no definite period of time from which the sufferer can date its beginning.
In the early stages there is loss of appetite, and a pronounced feeling of weakness, followed by a slight cdugh; the latter symptom frequently leads patients erroneously to believe that their trouble began with a had :cold, when, as a matter of fact, the catarrhal trouble of the throat and bronchial tubes was originally Broduced by the germs of tuberculosis.
As the disease,progresses, the victim complains of fever and chills. These symptoms are often periodic, leading one to believe that the trouble is malarial fever.
Rapid loss of flesh is one of the earliest and most common symptoms.
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Night sweats, which are very exhausting, occur frequently but are not invariable.
The symptoms above enumerated continue and grow worse, and in quite a large proportion of cases there is expectoration of blood, which in some instances may be so pronounced as to become a distinct hemorrhage.
3rd. TREATMENT OF THE DISEASE:-The treatment of tuberculosis by drugs, alone, has proven a failure, but recent investigations have shown that a large number of persons afflicted will recover if placed uncleI' proper hygienic conditions. In case of tuberculosis look first to guidance by your physician, then to sunlight, to open air, a nourishing diet and rest. Avoid alcohol in all its forms.
Inasmuch as treatment of incipient cases is so generally successful, do not delay having an examination made, if any of the symptoms mentioned present themselves.
4th. MODES OF INFEC'fION~:-Hereditary tuberculosis-notwithstanding the popular idea to the contrary-is practically unknown, though there is no doubt but that these persons in whose family consumption exists, are more prone to contract the disease, than are others. A tendency toward the disease, or a lack of resisting power may be inherited, but the disease itself is contracted.
In just what manner the germs of consumption gain entrance to the human body, we are more or less uncertain, but we are led to believe that in many instances,they pass in by rneans of the air as it is inhaled.
In a small percentage of cases, the infection gains entrance to the human body through an abrasion of the skin; or through some mucous membrane. Finally the germs are often taken in with the food that we eat, or by putting ob~ jects upon which they are present into the mouth, or by eating with hands which have been contaminated and not washed.
Milk is unquestionably the most common food through which we contract the disease. as a large percent of cows have tuberculosis, and in this case, their milk is frequently infected with the germs.
'Of quite as much importance as the introduction of

the germ into the body is the resisting power of the individual at the time when this occurs, since the disease can make no progress unless the tissues have become susceptible through lowered resistance. All things then that have the effect of lowering the vitality of the body act as predisposing causes to consumption; such, for example, as want of proper food, lack of sleep, improper clothing in cold and wet weather, and living in damp and improperly ventilated houses; excesses, particularly the taking of alcohol, conduce to the development of the disease-long-continued inebriety being beyond doubt the cause that most frequently leads to consumption. It is a common error that alcoholic stimulants tend to ward off consumption, and it is highly probable that these supstances not only do not act in a curative way on those who have already contracted the disease, but are positively detrimental. In order then to avoid consumption-and this is particularly of importance for those in whose family there is a predisposition to the disease-the individual should live soberly, should try at all times to obtain a reasonable amount of good food, should sleep a sufficient number of hours, and should be clothed .properly, particularly in the winter. Those who devote their time and energy to the performance of their work-being careful of course not to labor excessively-are much more apt to escape consumption than those who do otherwise. It is particularly of importance that those who have a tendency towards consumption should early learn, and throughout life practice the habit of breathing through the nose; if this rule be followed there is no question but that a large percentage, not only of the germs of consumption, but other bacteria as well, are filtered out during their passage through the nose and do not reach the lung s\1bstance. Cleanliness is also of importance-a bath taken each morning in moderately cold water being conducive to health, not only as regards consumption but other diseases as well. It is of course necessary that dwelling houses should be kept thoroughly . clean.
5th. ADVICE TO DISEASED PERSONS :-In all cases where a person observes in himself, or in those for whom he is responsible, the symptoms already detailed, it is his duty to con-

suIt at once an intelligent physician, and if it be found that tuberculosis is present, every precaution should be taken by the diseased individual to prevent the further spread of the malady. The sputum that is constantly being coughed up contains myriads of the germs, and it is of the utmost importance, in order to prevent other persons in the neighborhood from being infected, that it be destroyed. The patient should at all times carry about with him either a small receptacle for expectoration or a large cloth which would answer the same purpose, and in either case the sputum should be burned; if this be impractical, it should be placed in a solution of some good antiseptic, such as a saturated solution of carbolic acid, or a 1 to 1,000 solution of corrosive sublimate in water. The patient's handkerchief should be thoroughly boiled, and his clothing should receive like treatment. Every precaution should at all times be observed in order to prevent the sputum getting on the furniture or floors, as, under such circumstances, it quickly dries and being broken up into small particles is carried by means of the air to other parts of the house.
The patient should always remember that the quicker he is placed under proper treatment, the more the chances of ultimate recovery; in the early stages almost all of the cases are curable, but later this is not often accomplished.
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CHAPTER VIII.
2.-DIPHTHERIA.
Diphtheria is a germ disease produced by the diptheria bacillus and is among the most communicable and fatal maladies of children. It is common to all climates and occurs most frequently during the winter months.
CAUSE OF THE DISEASE :-The germs grow generally on the mucus membrane of the tonsils, but often exist in the mouth, the nose, and the wind~pipe.
There are various symptoms: Sore throat is practically always one of the first; then the temperature rises and there is lassitude and that peculiar appearance of the face which is often seen in serious illness. Generally, there is a "kidglove-like" membrane formed on the tonsils; in the nose, or throat. In the formation of this membrane poisons are produced from the germs. These are absorbed into the general system and produce the symptoms named above. So variable are the effects of the infection that all children with evidence of sore throat or inflamed tonsils should have cultures made from their throats before they are allowed to continue in school. This is already the custom as well as the law in many cities. The mild cases often recover without treatment, but a large percentage of those affected with the severe type succumb to the disease, especially if proper attention is not given. Several cities in our State provide tubes for cultures in order to make sure of the diagnosis, and the State Board of Health at Atlanta will do likewise for the people at large. TREATMENT:-Treatment of this disease should always be under the direction of a physician. The discovery of antitoxin has reduced the death rate to one-third of what it was a few years ago. This remedy is made at the laboratory of the State Board of Health at Atlanta, and is furnished free to all citizens of Georgia who may need it and are not able to pay for it. MODES OF INFECTION :-Through the air passages, the germs
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usually gain a hold in the nose, mouth, or tonsils. This is not the only method of infection, as the germs are often taken into the mouth through pencils, chewing gum, and food-especially milk.
Inasmuch as the disease is so readily transmitted, and the germs linger in the throat of the victim after apparent recovery, the doctor's certificate should be required before a child who has recovered from this malady returns to school.
PREVENTION : -We readily see from the above discussion that an ounce of prevention is worth a pound of cure.
It is well to insist upon thorough examination of all suspicious cases of sore throat.
Isolation and quarantine of all cases of diphtheria, and thorough disinfection of the apartments to which the patients have had access should be required. All persons known to be exposed should be closely watched for symptoms. Only by rigir'y following these instructions can the disease be prevented and controlled. (See note on disinfection following article on typhoid fever.)

CHAPTER IX.
3.-TYPHOID FEVER.
Typhoid fever has existed in our State for many years and its percentage of fatalities is great.
This being a germ disease is preventable. The following article will enable you as teacher to "aid in ridding the people of this menace to public health.
CHARACTER OF THE DISEASE:-This fever develops, as a rule, quite slowly, the first symptoms being loss of appetite, headache, and a marked fatigue on slight exertion. The symptoms gradually grow worse, fever develops, and the patient often suffers with chilly sensations. The temperature gradually rises. In,many cases no symptoms exist that indicate inflammation in the bowels, but in the severe forms, diarrhoea usually comes on during the first week and continues throughout the course of the disease. During the second week, the above symptoms are more severe. When the disease follows a normal course, the symptoms during the third week gradually abate.
The mortality of this disease varies from five to twenty per cent., depending upon its character, and the nature of treatment and nursing that the patient receives.
TREATMENT OF THE DISEASE :-As soon as the symptoms already detailed appear, the child should be sent home and placed under the care of a physician.
MODES OF INFECTION :-It is clear that typhoid fever is the result of the entrance into the body of some minute form of germ life; whether this be the bacterium generally supposed to induce the disease or not, this contagion is beyond question a living something which multiplies with great rapidity under proper conditions, and, escaping from the bodies of those infected with the disease, in one way or another, reaches other individuals. It is beyond question true that the virus passes from the body of those infected by means of the excretory
K,

organs, and it is likely that the secretions from the mouth and nose freqt:ently contain the germs that cause the fever.
As the germs are extraordinarily minute, a very small amount of any of them might produce the disease in healthy individuals if they were to get into their bodies through water, milk, or any uncooked food, find lodgment about the riose or mouth, or get upon the hands of other persons. It should also be remembered that the virus may easily get upon cooking-utensils, drinking-cups, bed-linen, and other articles with which we are constantly brought into close contact, and that the disease might be transmitted in this way. The malady may be carried from place to place by insects. particularly flies; the latter may readily get enough infectious material upon their Jegs in various ways, and then, crawling over food, leave the deadly poison deposited upon it.
ISOLATION OF PATIENTS :-Wherever possible, patients with typhoid fever should be completely isolated, since, if this is not done, other members of the family are almost sure to contract the malady-a result which almost everyone has seen who has had any experience with the disease. \Vherever possible, patients should be sent to a hospital, but where this can not be done they should be isolated as much as possible. \Ve should be particularly careful to prevent children from coming in contact with them, as it has been shown that they contract the disease much more readily than grown people. It is also of importance that persons should not, unless compelled, sit for any length of time in the room with a person suffering from typhoid fever, and, above all, under no circumstances should cooking and eating be done in t;~e sick chamber.
The room in which the patient is placed should be furnished only with those things absolutely necessary, and it is particularly desirable that carpets and curtains should be removed. It is well to wash the floor each day with some antiseptic sofution.
Those persons who come in contact with typhoid fever patients should wear outer clothing which can be easily washed and boiled. After touching the patient, or any of his clothing, the hands should be at once thoroughly scrubbed in an
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antiseptic solution. Of course, under no circumstances, should the nurse eat or drink from the same vessels with the patient.
DISINFECTION.-All clothing that comes in contact with the typhoid fever patient should be thoroughly disinfected. This is best accomplished by boiling, but in cases where this can not be at once carried out, it is advisable to use some chemical antiseptic; of these, perhaps the best is creocarboline, which may be employed in a 1-500 solution in water; where this substance is not obtainable, a 5 per cent solution of carbolic acid in water, or a 1-1000 aqueous solution of corrosive sublimate may be employed. The floors should be daily washed with one of these solutions.
The water in which the patient is bathed should likewis<~ be disinfected, either by the addition of an ounce of creo-carboline, or four tablespoonsfuls of .chloride of lime; disinfection will be brought about in half an hour, when these directions are followed.
The hands of those coming in contact with the patient should likewise be thoroughly washed, either in a solution of carbolic acid, or corrosive sublimate of the strength just mentioned.
Of greatest importance is protection from polluted water, milk and food. The fly often carries the disease. Lack of attention to outhouses is a prolific source of the malady. Circulars showing proper construction of closets will be furnished on request by the State Board of Health.
DISINFECTION of ROoM.-After the patient recovers, the room should be disinfected with formaldehyde gas obtained from the substance known as "formalin." When everything is ready, and the room properly sealed, thirteen ounces of permanganate of pota~h to each quart of formalin are placed in a large vessel, the room being closed immediately after the two substances are put together; it is important that the permanganate be placed in the vessel first. When this method is employed a quart of formalin should be used to each one thousand cubic feet of airspace in the room. As the gas, by this process, comes off with great rapidity, it is not necessary to keep the room closed as is the case when the older method is employed. Experi-
26

ments have shown that complete disinfection is brought about in four hours. This method is to be advised for the reasons that it acts more quickly than the older one, and there is never danger of fire.
In cases where houses are too open to permit of disinfection by means of gas, the sick chamber should be thoroughly washed with one of the antiseptics employed for sterilizing the clothing.
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CHAPTER X. 4.-SCARLET FEVER. Scarlet fever or scarlatina, as it is often called, is characterized by sudden onset with high fever, rapid pulse, headache, and sore throat. It gets its name from the peculiar scarlet rash, which appears on the second day after the attack. The exact causative agent has never been discovered, but it is no doubt caused by some very minute germ. It, too, belongs to the communicable diseases, and next to diptheria is the most dreaded of the acute ailments of childhood. It. like diphtheria, is more prevalent during the_fall and winter months. Every child with high fever and sore throat should be sent home at once, and scarlet fever suspected, if it exists in the locality. It affects children principally, Rnd while dangerous in itself, its after effects are also serious. Kidney trouble and acute middle ear disease, often leading to deafness, frequently follow even the mild attacks. Isolation and quarantine should be instituted in every case of this disease, and kept up until all of the scales are completely removed, and everything thoroughly disinfected. Those who have had the disease should be looked upon as possible source for infection until physician's certificate is received. For disinfection, see this topic under typhoid fever.
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CHAPTER XI.
5.-SMALL POX.
Until the beginning of the nineteenth century smallpox was the terror of mankind. Where it originated is a matter of doubt. It is, however, certain that it existed in Egypt about the middle of the sixth century, A. D. It was brought to America by the Spaniards.
Its onset is usually sudden, beginning with a chill or chilly sensation and pain in the back, and where the disease exists in a locality, a teacher' should at once send a child home, if suffering with these symptoms. It is communicable from the beginning.
The child should not be allowed to return to school until all scabs are removed, and its clothing and home disinfected.
The story of the inoculation of matter from the hand of the dairy maid-suffering from cowpox, contracted by milking -into the arm of an eighteen year old boy, and the failure of the latter to develop smallpox, is familiar. This test was made by Edward Jenner in 1796. He quickly proved the value of vaccination and it was introduced into this country in 1800. By modern methods, we have eradicated practically all of the danger attending the procedure, and the same principle used one hundred and twenty years ago is still in practice.
So effectual is vaccination against smallpox, that a German physician, in writing an article on the subj ect, states that he has had no opportunity of studying the disease in any of its iorms in his large clinic for the past nine years. This was the result of strict vaccination and revaccination in Germany.
If every person in our State were vaccinated this disease which takes its toll of human lives and of thousands of dollars from us every year would soon be a thi'ng of the past. Can we not see what it has done for others and apply it for our own protection?
For disinfection note this topic under typhoid fever.
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CHAPTER XII. 6.-MEASLES. Measles is a. far more dangerous malady than many think. It, too, belongs to the communicable diseases, but the exact lIature of the organism producing it is unknown. We do know, however, that it is considered the most contagious of all the eruptive diseases. The contagious period lasts from the very first symptoms until the complete disappearance of the eruption. The period of time from exposure till the fir~t symptoms are seen is usually from 10 to 12 days, the eruption appearing about 3 days later, or the fourth day of the fever. Reddening of the eyes, sensitiveness to light, headache, sneezing, and the appearance of a cold are usually the first symptoms. The eyes should receive special attention, as many defects of vision are caused by inflammation during this disease. The child should be well protected from exposure, as cases of lowered resistance leading to tuberculosis have lwen traced to this cause. A splendid ,youth, an honor man in one of the best colleges in Georgia, traced his decline in health to exposure during measles. Fourteen years of stll(!y altt~ the attendant expense, as well as a bright and valuable life were lost from this indiscretion.
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CHAPTER XIII.
HOOKWORMS.
Of all the intestinal worm diseases, Hookworm is the most important subject of study in our section of' the country. It is said to cause either, directly or indirectly, more death'"
among the children and more poverty amons grown people
than any other disease. These worms live in the small intes" tine. The number present vary from a few to thousands. They are found principally, so far as the United States is concerned, in the Southern States, although quite a number of cases have been reported from the North. They are grayish white in color, about the size of No.1 thread and about a half inch long.
(
BClOk.Wo~, Natural Size; The Smaller is the Male
The worms live in the intestine, but do not multiply there. They lay eggs by the thousands, and these pass OUt of the alimentary canal. iH they are allowed to get in the soil, they hatch out very small worms, each egg producing one worm. After a few days these small embryos, as they are called, have the power to penetrate the skin of a person, c~tt:-,ing "ground-itch" or "dew-poison," the condition very frequently seen among children who go with bare feet. Doubtless these small worms are occasionally taken into the boJy with uncooked food and in unclean water.
Hookworms not only suck blood from the sufferer, but also inject a poison into the body. This causes the lack of red blood corpuscles (anemia) a condition often seen among children. These worms do not remain always attached to the same spot in the small intestine, but go from one place to another, each time leaving inflammatiun. This disease is often mistaken for malaria. The sufferers are con-

sidered lazy, shiftless, indifferent, and backward, :.n<1 many have been punished for these supposed traits wI:n IJroper treatment for Hookworm disease would have renJoved them. One suffering from hookworms shows the following symptoms: paleness, a whitish yellow skin, lack of physical development, a peculiar white glistening eye, and dry hair. Some patients have a peculiar desire to eat such things as dirt, chaik, and sticks.
Hookworm disease is most common in districts which have sandy soil, as sand, heat, and moisture are favorable to the growth of the worm. Children suffer more frequently than grown people, as they sometimes go with bare feet. It is not confined to children, nor to the country entirely, and may be found in the rich as well as the poor. It occurs almost exclusively in the rural districts, and is practically confined to those who go barefooted or wear leaky shoes.
The eggs of the worms get in the soil only from people who have the disease, so proper cleanliness and proper sanitary conditions around our homes, horselots, school houses, and churches, would soon put an end to the malady.
The following incident which occurred in one of the prisons in the Philippine Islands, illustrates the effects that hookworms have on a community. Attention was called to the fact that about seventy out of every thousand of the inmates died every year from diseases which were not considered so fatal as to give this high death rate. A systematic examination of these prisoners revealed that a large majority had hookworm disease. All suffering from it were treated and the following year only twelve out of every thousand died. It is not unreasonable to suppose that this disease caused many deaths among the prisoners held at Andersonville during the Ciyil "Var. A certain young man in a Southern school, in the beginning of his high school life, was always at the foot of his class. Every form of punishment used in this institution was tried on this boy but with no result. He was examined and found to be suffering with hookworm disease, and in less than two months after treatment, he ranked among the best students and brightest minds in his school.

:\UVICE 'ro SUI<'H:RERS:-\Vherever symptoms of this disease are discovered, or suspected, medical advice should be obtained. The malady yields rapidly to treatment, and this is simple and inexpensive. The diagnosis is easily made by microscopical examination.
( For circulars on Sanitary Surface closets and other information concerning' this subject, write to the Georgia State Boanl of Health. Atlanta, Ga.
Fig. 3.
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CHAPTER XIV.
INSECTS INJURIOUS TO HEALTH.
It is a known fact that many diseases are transmitted by insects. A certain species of the mosquito carries the infection of malaria, and another, the germ producing yellow fever. The common "house fly" on account of his filthy habits, is known to carry the germs of many communicable diseases on his feet and to deposit them on our food. Such an important part does he play in the transmission of typhoid fever that he is often spoken of as the "typhoid fly." The ordinary cat or dog flea as well as the rat, is supposed to carry the germs of bubonic plague. It is well then to consider the means of protection from typhoid, malarial, and yellow fever, in so far as insects are concerned.
The house fly is born in filth, lives on filth, and carries with him filth. Protection from him means protection from many diseases. Sanitation is our only safeguard. Keep a clean stable, have on your premises a sanitary closet, and keep both clean; screen doors and windows, and when a fly gains entrance to your dining room, kitchen, or house, kill him before he can do damage. Remember that he does not wipe his feet.
Inasmuch as there are two species of the disease-carrying mosquito, which are numerous in our State, a short description of their peculiarities is not without interest.
The malaria-bearing mosquito is known as the Anopheles. His wings are more or less spotted. When resting on a surface, the Anopheles mosquito has the appearance of standing on his head. His body and wings are in line with his beak. This mosquito rests during the day and bites during the night.
The yellow fever mosquito, or Stegomyia, is slightly larger than the ordinary varieties. He is striped, or zebra-like, and can be seen flying around during the day time.
It must be understood that neither variety of this insect
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can transmit disease without having bitten a person suffering from malaria or yellow fever.
Mosquitoes breed in stagnant water, and for protection against them, all pools should be drained and vessels containing water should be emptied during the summer. Where it is impossible to drain, kerosene oil should be poured over the surface of all collections of water in the neighborhood of houses. For protection during sleep, the bedroom should be screened, or a net used.

1'IWL
ANOPB1n. . . .
_al.rial U-aailO.)

FtR.1. CULEX. (ComDlOD HosqolJo.'

(It will be observed tlhat the body of the malarial mosquito is almost straight and sticks out from the :surface on which it sits; the body of the common mosquito makes an angle and both be'ak 'and toil point tow3Jl'd the surface to which it is attached.)

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CHAPTER XV.
THE SCHOOL HOUSE AND SURROUNDINGS.
THE SITE :-The elevation and drainage, as well as the item of central location, should be considered in selecting a site for a school house. The lot should be at least one acre in size, and it should be the most healthful and beautiful spot near the center of the district. Instead of a bleak and barren hill, the children should have the comfort and beauty afforded by trees. Sluggish streams and marshes as well as manufacturing plants and places where offensive odors are emitted should be avoided. The building, as a rule, should be placed on the highest part of the lot. Handsome, well kept grounds, as well as modern sanitary buildings, are effective factors in raising the standards of education.
Provide walks and flower beds. Their care and culture are worth while from every standpoint.
THE WATER SUPPLY.-The water supply, whether well, spring or stream, should be carefully guarded from pollution by surface drainage or filth of any kind. Disease germs are often found in water that is agreeable to the taste and perfectly transparent.
In loose, sandy soil, tainted water is often carried underground for long distances. To guard- against contamination, the water used should come from a source as far removed as possible,from stables, pig pens, or closets. To prevent drainage lrom these and other dangerous sources, the well should be protected by cement or hard brick. A pump should be used where a well is the source of water supply; open wells too often are made the receptacle of all sorts of undesirable objects where children have access to them.
The sanitary drinking fountain is, of course, to be desired wherever attainable. The water bucket and common dipper ar~ being forbidden in many schools as prolific sources in spreading diseases of the mouth and throat. VIater coolers are
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"From Sc'hool Sanitationand Decoration" D. C. Heath & Company, Publishers.
cheap, much more economical than bills for medical attention, and an individual cup costs only a few cents.
THl~ BCILDING :-The school room should be approximately 2Jxa2 feet in size, and at least eleven feet between the floor and ceiling. No windows should be placed where children must face them when seated at their de~ks.
There should be a desk and seat for each pupil, separate ante-rooms for the boys and girls, and proper arrangement for heat and ventilation. Ante-rooms are not luxuries but necessities. Hats, wraps, and dinner pails in the school room are not merely unpleasant; they are sources of actual danger to pupils and teacher.
For a pleasing interior, much depends upon the coloring. That part of the wall space not occupied by the blackboard should be tinted in olive green or ~ray, while the ceiling should be of some soft cream color. If the light is strong, darker shades should be used. Inattention to these matters will be followed by injury to the eyes of the pupils.
HEATING AND V EWfILA'I'ION :-If stoves must be used, they should be placed in the corner, not in the center of the room. They should be enclosed in a sheet-iron jacket and some system of ventilation provided which will not cause a draft. The doors and wiridows shoukl be left open during intermissions in order that a supply of fresh air may be obtained. Much of the rest-
37

lessness and fretfulness of the latter part of the session is due to the fact that the bodies and minds of the pupils are depressed by the poisonous atmosphere, which has been breathed over and over again in an improperly ventilated school room.
FIRE HAZARD:-Two-story buildings should have outside balconies or iron stairs to the ground. Doors should swing outward in order to afford ready egress in case of panic. Fire drills should be practiced frequently. \-Vhere these are properly conducted, any ordinary school room can be emptied within a few seconds. Inattention to these matters has caused sorrow and loss of life.
INTERIOR DECORATIONS :-Do not compel the child to pass the formative years of his life in a barren, ugly school room. Pictures are cheap. Framed or unframed, they have a pleasing and helpful influence. By these, however, the "screaming" chromo or miserable daub is emphatically not meant. Worse than these are pictures representing scenes of horror and bloodshed. A thoughtful observer declared that much of the bad manners and roughness exhibited by the pupils of a certain school were due to the silent influence of "The Massacre of Custer" which with all its bloody details daily faced the pupils. Select scenes of great natural beauty, or the pictures of noble men and women.
Hanging baskets or window boxes are not difficult to secure and are attractive and refining. Almost any neighborhood can supply ferns and geraniums, and other flowers may be secured at little or no cost.
CLOSETS:-The feature about the average school which most needs attention (and has frequently never received it) is the closet. It appears to be regarded as a nuisance without remedy. We seem to be resigned to the idea that our children must be confronted here daily by shameful (and sometimes obscene) conditions which are a disgrace to civilization. These conditions should no more be allowed at school than at home. The school closets should be kept clean. The responsibility for this should not be placed upon the teacher alone--!particularly if she is a young lady.
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How should this work be done? Put the closets m good condition. Provide a lock and key and require frequent inspection. If the dry closet is a necessity, write for a good 1110del. The tate Board of Health will be glad to furnish this without charge. Build a screen before the door and plant vines for further protection. Do not neglect this matter. The welfare of your child demands this attention on your part.
Example of a well-screened closet.
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