Health Education in Rural Schools

Health Education in Rural SchoolsAuthor(s): Jean E. BrowneSource: The Public Health Journal, Vol. 11, No. 12 (DECEMBER, 1920), pp. 533-541Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41972633 .

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tbe Public fcaltl) Journal

Vol. XI. TORONTO, DECEMBER, 1920 No. 12

Health Education in Rural Schools

By Jean E. Bbowne, Director of School Hygiene, Provincial Department of Education, Saskatchewan.

THE cating term

as Health

it does Education

the trend is of in modern itself rather

opinion. significant,

A few years indi-

cating as it does the trend of modern opinion. A few years ago, in speaking of health work in the schools, one heard only

the term "Medical Inspection." Medical 'Inspection had its incep- tion in 1879 in Paris, and meant inspection of school children for contagious diseases. Shortly afterwards it was introduced into Germany, and in 1891 we find its beginning in London, England. We find it first in the U. S. A. in the city of Boston in 1894. In 1902, the first school nurse in the United States worked out a very successful experiment in New York City. It is hard to fix the exact date, but about the beginning of the twentieth century medical inspection of schools which before had for its object the reduction of contagious diseases began to take on a broader meaning, and a beginning was made in examining children for physical defects such as defective vision, defective hearing, enlarged tonsils, adenoids, decaying teeth, etc.

But those who were making a study of child welfare soon began to see that inspection work alone would never get us very much farther ahead, and gradually there came to be evolved out of the old idea of Medical Inspection - the idea of Health Education. It includes as one of its phases at the present time the inspection of children for physical defects, but it aims at something infinitely bigger and better, physical perfection. Its aims is the prevention of defects, the removal of which occupied the whole time of the old systems. In a system of Health Education, the self-activity of the child is our starting point. In the old systems of Medical Inspection this well-proven pedagogical principle was scarcely considered. The principle on which Health Education is based, is the essential

533



534 THE PUBLIC HEALTH JOURNAL

principle underlying all education, that is, that the child is an entity, and there is no sharp line of demarcation between the mind and body, and that education means the development of the whole child.

When teachers grasp this fundamental idea, there will be no lack of harmony in connection with health' w;ork in the schools. It is largely a matter of getting rid of the old pernicious tradition that a child can be divided into three separate compartments dis- tinctly labeled "Physical, Mental and Spiritual." When we think of the child as a whole, we can then plan for the development of the whole child. It seems to have been due to a lack of understanding of this that in many instances in the past our teachers were trying to devote themselves exclusively to the education of children's minds, while another set of professional people were attempting to look after the same children's bodies. Both of these professional groups have been characterized by narrowness of vision, and in the struggles for their rights, the rights of the child have been largely overlooked. In teachers' conventions you used to hear the invidious comparison made between the respective incomes of the men who merely looked after the needs of the body and those who ministered to the needs of the mind. On the other hand, we frequently hear child welfare discussed in health conventions as if it had only to do with healthy bodies. Recently in a nursing journal I came across this : "The average person would be horrified to find that the teacher who taught his children had no certificate, and yet nothing of em-

ploying a wholly untrained or half-trained person for something infinitely more important - their care during a serious illness. I think most of us would hesitate to admit that there is anything "infinitely more important" than the education of a child. As a matter of fact, one of the great weaknesses of the old system of medical inspection was this sharp line of cleavage. The more elab- orate the system, the more completely was the responsibility of the child's health taken from the teacher. Obviously this was working from a wrong standpoint, since the education of mind and body are indissolubly linked together. With this principle in mind, let us not take this responsibility from the teacher, but rather let us pre- pare our teachers to educate the child in his entirety. To be sure, the teacher of yesterday thought it her business to teach the cur- riculum - no more, but a transformation is taking effect in our schools, and we find the teaching profession are coming to realizez that their business is to understand and direct the lives of their pupils and to realize that education means development of the whole child.



THE PUBLIC HEALTH JOURNAL 535

But the teacher must have training along health lines, and so our normal schools will have to commence to give an earnest course in School Hygiene. To be sure our Normal Schools have always had hygiene on their programme, but if the work given in this subject in the largest normal school of Ontario some years ago may be taken as an example, then it might far better have been left off, because it left the idea with the students that hygiene was of no importance. The only lasting impression I have of it was a ven- erable old gentleman, who was an authority in his specialty in anatomy, exhibiting to the class specimens of the various kinds of bones and joints, and talking to us about a jacketed stove. It isn't likely he had ever been inside a rural school. The course in hygiene should be taught with one aim in view - to teach teachers in training how to conserve the health of their pupils and how to teach health habits. This teacher of hygiene must be a trained teacher and must be thoroughly familiar with the conditions that obtain in our schools, particularly in rural schools. In Saskatchewan, we have on the staiï of each of our Normal Schools, a school nurse who has had pedagogical training. She gives lectures in Physiology, Practical School Hygiene, Firt Aid and some Home Nursing. She inspects the students for physical defects and urges on them the necessary treatment. In classes A. B. and C. at the Regina Normal School this year there were 143 students, 117 of whom had remediable defects. Of this number 114 received the necessary treatment. The teachers in training are taught to use a Snellen's Eye Test card, and to roughly test their pupils' hearing by the watch method and the whisper method. They are also taught to detect adenoids and diseased tonsils. They are particularly taught the care of the teeth, and are warned of the importance of preserving sixth-year molars in children. They are taught the symptoms of chores. The teacher who does not recognize the sign of this disease is almost bound to

punish unjustly and so to aggravate the disease. They are taught the signs of incipient tuberculosis. I have known of a considerable number of cases of incipient tuberculosis which have been reported by observant teachers before the cough occurred. They are particularly taught the necessity of having hygienic conditions in re-

gard to the lighting, heating, ventilating, desks and seats, cleaning, and toilets of the school. These points that I have mentioned will

possibly give you an idea of the kind of work being given in the School Hygiene Course in our Normal Schools. For the older teachers and the teachers who come to us from outside, we have a

Health Education course at the Summer School at the University.




This course consists of Physiology, Practical School Hygiene and Physical Culture. It is a great mistake to have School Hygiene and Physical Culture separated. They are both integral parts of Health Education.

I believe that a wise course of study in hygiene taught by teachers who are impressed with the importance of this work this our greatest single instrument in Health Education. Last year, for the first time, hygiene was made a compulsory subject in our province from the time the child entered the elementary school until the end of the third year of the secondary school. During the first two years, however, there is no formal teaching of hygiene. It is a matter entirely of fixing right health habits in pupils. Now it would be ideal if our teachers were so widely read and so well in- formed as not to require text books at all, but at the present time much depends on the selection of texts. We use a graded series of text books by Ritchie :

For Grades III. and IV. - Primer of Hygiene. For Grades V. and VI. - Primer of Sanitation. For Grades VII. and VIII. - Primer of Physiology.

First Year Secondary Schools:

Text - The Saskatchewan Public Health Act - Regulations and Bulletins - Bulletins issued by the National Commission of Conser- vation.

Such topics as the following are dealth with : 1. How a supply of pure water may be obtained in the locality

in which you live. Conservation of rain water. 2. Pure Food Laws.

Regulations governing the sale of milk for domestic use. The part played by flies in the pollution of food.

3. Contagious Diseases. Typhoid Fever, Tuberculosis, Measles, German Measles,

Whooping Cough, Influenza, Chicken Pox, Small Pox, Scarlet Fever, Diphtheria, Mumps, Trachoma. Characteristic features of each and mode of transmission. Regulations for isolation and quarantine.

4. Union Hospitals - How Organized.

Second Year. Text - Human Physiology - Ritchie. Chapters I. to XIII. in-

clusive.




Third Year. Text - Human Physiology - Ritchie. Chapters XIV. to XXVI.

inclusive. Through teaching of this sort we are building up self- constituted health corps among the older boys and girls. Not long ago a group of High School girls on the playgrounds of a small town school discovered that one of the number had a rash. They went inside and consulted a pasteboard card showing the symptoms, period of incubation and period of isolation of each of the common contagious dieases. One of these cars hangs on the walls of every class room in the province. After consulting the card, the girls decided that their class-mate had chicken-pox. She asked permis- sion to go home. The family physician was called in and corrobor- ated the diagnosis. In a prospectus sent out by the World Book Company, it is stated that four children, after reading the Primer of Hygiene, discovered for themselves that they had adenoids and insisted on their parents taking them to the family physician. In educational work of any kind, our greatest asset is the self-activity of the child, and we shall make a sorry failure of Health Education if we do not make use of this principle. Possibly there may come a time when the teacher, the family physician, specialist- dentist Medical Health Officer and parents will be able to manage the Health Education of the risiiļg generation in rural schools, at any rate, without assistance. But that time has not yet arrived. And so we must provide for special health teachers, a group of

people who are specially trained in both hygiene and pedagogy. In Saskatchewan we have school nurses, most of whom have been successful school teachers before taking a nurse's training. They are given a short post-graduate course in our system before being sent into their fields. In New York State they take registered nurses with matriculation standing into the State Normal School and give them a year's course in Pedagogy, School Hygiene, and

Physical Culture. They are called Health Teachers. They have the

advantage over our School Nurses in one respect at least, in that

they are qualified to direct work in physical culture. In the Univer-

sity of Mississippi a special two years' course in Hygiene is given to train teachers to be Health Teachers. These courses have been

planned with the idea that health is a matter of education, and that health education is an essential part of education.

The principles of health education are the same whether in rural or urban schools, but the necessity for the rural work is greater. In Saskatchewan 77 % °f our school population is rural, so that our

problem is overwhelmingly rural. In considering this work, we




must also bear in mind the fact that the health standard in rural communities is generally lower than in cities. There are few, if any, organized health activities in rural communities so that if the school shirks its responsibility, the outlook is dismal indeed. Health work in rural schools cannot be copied from cities. A too ambitious programme in rural schools defeats its own ends.

Permit me to outline for you how this problem is being met in Saskatchewan. In April, 1917, the Minister of Education, who is also the Premier of the province, appointed a Director of School Hygiene to organize a provincial school hygiene branch. In connection with this branch there is a gradually increasing staff of specially trained school nurses, most of them with pedagogical training. At present this work is financed entirely by the Govern- ment, and the unit of operation is for the most part the inspectorate. The school nurse travels with the Inspector in fine weather in his car, and conducts her inspection work at the same time as the school inspector. This works out without any waste of time for either. Its disadvantage is that it allows the school nurse very little time to visit parents. In winter time, she inspects schools in towns and villages along railway lines. Ultimately this work will have to be undertaken and financed locally, but under our present form of administration, the small school district with its school board of three members, this is an impossibility. We are still hoping for the larger unit of school administration, whether it be the municipality or a still larger unit. In the meantime a considerable number of municipal councils are interesting themselves in this work. At their request, we send one of our School Hygiene staif, and the council arranges and finances her transportation from school to school within the municipality.

The one-room rural school is the pivot round which our system chiefly revolves. Out of 4475 school districts, about 4000 are one- room rural schools.

But it is worse than folly to attempt to teach health in a school that breaks all the laws of hygiene. Children are very quick to detect inconsistencies in grown ups. Our present and very pressing duty then is to put right with as little delay as possible the hygienic conditions of our schools. The first definite piece of work undertaken by the School Hygiene Branch in our province was to send out a questionnaire dealing with hygienic conditions to all the rural and village schools. A bulletin was then prepared based on the replies to this questionnaire. I submitted this to the Deputy Minis-




ter for publication, but it looked almost too bad to print. However, after inserting the following paragraph, it was finally printed :

"In regarding this survey as a whole, we find that it offers im- mense opportunities for improvement. On the other hand, it com- pares favourably with conditions as revealed by surveys which have been conducted in the United States. It is altogether probable that it would compare not unfavourably at least with conditions exist- ing in other provinces in Canada, but to the writer's knowledge, no such survey has been conducted elsewhere in the Dominion."

During the three years that have elapsed since this bulletin was prepared, conditions in regard to lighting, heating, ventilating, water supply, washing facilities, general cleanliness, school toilets and desks and seats have been on the whole greatly improved. Our method of attacking the problem was to issue pamphlets on the most neglected phases of School Hygiene, and to conduct school hygiene exhibits at Trustees' conventions. But our most effective means has been the work of the nurses on the Provincial School Hygiene staff. Besides inspecting the pupils in our schools, these nurses make detailed reports on the hygienic conditions of the schools. They send in definite recommendations to the School Boards and they are asked to report a little later what has actually been done. In cases of continued neglect, the school Inspector recommends a discontinuance of the Government grant until the most urgent improvements are made.

I do not think that this phase of health work can be over-estim- ated since it spells prevention. As a people we are still more con- cerned with the treatment of disease than with its prevention. How ready a response meets the appeal for the immediate needs of a tuberculosis child but how loath we are to spend money that will prevent hundreds of children from developing the disease. We cannot afford to economize on the hygienic conditions of our schools. I remember about six years ago being home on a vacation in my home town in Ontario just after there had been an inspection of the pupils. There had been a clinic in connection with this work, and a number of children had been operated on for tonsils and adenoids, and a number of them had glasses fitted. All of which was excellent. I marvelled, however, that nothing had been done to im-

prove the school, and I asked if I might see the report that was made to the school board regarding the hygienic conditions of the school. But no such report had been made. And so the old school was left to keep on Breeding unhealthful conditions. I think I must take a moment to describe it. It was an old four-roomed frame building




situated on grounds inadequate in size and so low as to be covered with mud except in dry weather. In summer, the grounds were covered with dank weeds. Two of the rooms were lighted on oppo- . side sides of the room, and in all four the amount of window space was grossly inadequate. Two of them had only north lights. The seats were all stationary and double at that. The blackboards were shiny, and opaque window blinds were used ! No means were pro- vided for the pupils to wash their hands. Drinking water was sup- plied in an open pail, beside which rested that old criminal, the common drinking cup. The floors were dirty and the rooms dusty but worst of all were the outside toilets. They were really too offen- sive for me to describe to you. I have related this to illustrate how short-sighted has been some of the so-called health work carried on in schools.

At the present time, however, the need of inspection for physical defects is great. Our school nurses find throughout our province that 88% of the pupils inspected have physical defects mostly of a remediable nature. One of our greatest difficulties in this connection is the scarcity of dentists in the smaller towns. Although we did riot expect intensive results since our work is spread over such large areas, still we find that 2295 rural children had defects reme- died last year as the result of notifications sent home by our school nurses. But in undertaking any such work there always remains a considerable number of children whose parents are not able to pay for treatment. The Junior Red Cross in our province has now stepped into the breach and is undertaking the treatment of such children.

Important as inspection work is we must always remember that our aim is Health Education. We believe that there lies ahead of us a golden day when because of the education of all the people, there will be no need of sanitoriums. I have been told that this school work could have no relation to Infant Welfare and pre-natal work. I am not so sure. When girls are taught in school the intelligent care of their own very wonderful bodies and the sacredness of human life, they will not rush into motherhood lightly. There is no end of literature on the care of infants and on pre-natal work, but the difficulty is that expectant mothers do not realize the need of securing it. A good deal of what is distributed finds its way into a waste paper basket. Medical science can do no good in a general way until the people begin to appropriate it themselves. And it is at this point that the Health Education work of our school bridges the gap.




The cure of all the troubles of this restless world is Education and as a part of that great panacea we claim a forward place for Health Education. When this work is firmly established we shall see a glimpse of what St. John saw in the Revelation - "And I saw a new heaven, and a new earth."



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Health Education in Rural Schools