Vienna, 1884) and A. Meinong (Über philosophische Wissenchaft und ihre Propädeutik, Vienna, 1885) treat of the subject with special ref erence to conditions in Austria. Among the numerous annual school reports on the subject I would mention Kränkel (Lahr, 1891) and Polle (Dresden, Vitzthumsches Gymnasium, 1894). A treatise of my own in the Zeitschrift für die Interessen des Realschulwesens, 1882. Also manuals by Mathiae, Beck, Rumpel, Hollenberg, Jonas, and others.

CHAPTER VII.

MEANS FOR SPREADING HYGIENIC KNOWLEDGE AMONG THE PEOPLE.1

By LEO BURGERSTEIN, of Vienna.

Contents.-I. Means of hygienic instruction concerning children and instruction of children themselves: (1) By distribution of printed matter; (2) courses in normal schools and common schools; (3) secondary schools.

II. Means for the general spread of hygiene: (1) University extension; (2) associations, popular lectures, reading rooms, books; (3) the influence of the clergy; (4) itinerant teachers; (5) portable exhibits.

III. Means for spreading hygienic knowledge among the professions: (1) Special schools; (2) lectures to nurses; (3) technical schools; (4) administrative officers, physicians. Theses.

The following paper, though written with reference to European conditions and read in a European scientific convention, is here offered in translation on account of its numerous practical suggestions, many of which deserve attention in this country also. Prof. Leo Burgerstein has been a frequent contributor to the literature of the science of hygiene and his suggestions toward popularizing it have everywhere been received with favor. He says:

My efforts with regard to the subject before us will be directed toward outlining the means practicable for the dissemination of hygienic knowledge among the masses of the people, as well as those applicable only to a restricted number. I shall amplify the text with appropriate examples from different states and nations.

A broad dissemination of knowledge is most quickly and easily effected among a population most of whom know how to read; where common schools are in the first stages of development it is difficult; the absence of these beneficial agencies makes it altogether impossible. The only immediately effectual means possible in the last case are the instructing and sending out of itinerant teachers with portable exhibits and the thorough education of those who enter the priesthood.

1 A paper read before the members of the International Medical Congress, held in Moscow, Russia, August 19-26, 1897.

See Annual Report of 1895-96, Part II, page 1175: "Mental Fatigue in School," where his publication on "Arbeitscurve" is mentioned.

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I. MEANS OF SPREADING HYGIENIC KNOWLEDGE CONCERNING CHILDREN AND THE INSTRUCTION OF Children Themselves.

1. DISTRIBUTION OF BRIEF TRACTS AMONG PARENTS.

With the supporting influence of State officials, the mutual cooperation of specially adapted societies and authorities can effect at a comparatively small expense the issne of brief tracts fitted to the comprehension of the masses. These may be distributed by authorized persons on suitable occasions, such as follows:

(a). At marriages, by the officiating parties, who should at the same time cantion against their falling into the hands of children or minors.

(b) During the technical instruction of midwives, by those duly authorized and within specified periods of time limited by scientific progress.

(c) At the registration of births, instruction may be given in printed form by the acting clergyman or civil officer. Contents: Repetition in part of the hygiene of children during the first days of life, the dangers of eye and mouth diseases, their prevention, and the necessity of immediate medical treatment; significance and importance of vaccination; requirement of heat, temperature of baths, indispensability of cleanliness, care of the skin, and the organs of sense; nourishment by means of mother's milk or the milk of animals, time for the introduction of other food and its kind, caution against stimulants and narcotics; the treatment of weak children; exercise in the open air; dangerous playthings; protection of children against early study; the symptoms of the most frequent contagious diseases; the necessity of medical assistance. At the presentation of illegitimate children for registration, the printed matter mentioned under (a) should also be handed ov

over.

(d) At the entrance of children at school.-Contents: Hygiene of children during the first years at school in respect to daily order, necessity of sleep, exercise, fresh air; hygiene of food; care of the skin, clothing; hygiene of study, position while reading and writing, carrying books, dangers of mental overexertion by other than school requirements; participation in pleasures deleterious to the child's organism; danger of employing children to earn money, both with regard to their age and the nature of the work required; increased danger of infection by attendance at school; duties pertaining to the prevention of the spread of infectious diseases; stoppage of the nasal canal; running of the ear, recommendations to caution children against such indulgences as tend to provoke thoughts, words, and actions which they would hesitate to make known to their parents. Dr. H. Cohn, among other subjects, specially agitates this one in printed instructions to parents.

As far as I know, France alone has taken measures toward distributing tracts among parents. In pursuance of a report of the advisory committee on public hygiene (the author of the report is Mr. H. Napias), the department of public instruction has ordered that in cases where children have contracted a contagious disease teachers must forward to the parents a pamphlet of instruction on the prevention of the spread of the disease.

As in most European countries statistics furnish the dates of marriages and births, as well as the number of children attending school, it is easy to determine the number of copies necessary for experimental proceedings in a single province. Expenses could be kept down by being partly defrayed by the individuals specially interested in the spread of hygienic knowledge. Everyone should be obliged to obtain the pamphlets, free of charge in most cases. If copies in more elegant finish and binding were offered for sale at a profit of 20 per cent, a considerable proportion would surely be sold. On such occasions as marriages and births, parents, if they could at all afford it, would willingly pay the prices asked for the booklets.

It is unquestionably true that children can be thus cared for in a great measure, from the day of their birth until they themselves are instructed in personal hygiene. Success will not attend every effort, of course, but considerable benefit may be

expected, since the instructive instinct of a mother for her child is thereby appealed to.

If similar pamphlets or booklets were sold by book dealers, the method proposed would lose much of its influence. It is, however, applicable in communities other than where the knowledge of reading is prevalent, as the acting official can inquire into cases where the ignorant may have the articles read to them by those informed. Beneficial societies, of which I shall speak later on, are capable of much good work in those lines.

2. DISSEMINATION OF HYGIENIC KNOWLEDGE BY MEANS OF SCHOOLS.

(a) Elementary, or common, and normal schools.—The subject of hygienic instruction in elementary schools should form a definite, systematically arranged series of important topics, discussed in such a way that children may be interested, and not taxed beyond their intellectual capacity. As instruction in elementary schools is conducted by one teacher, such an arrangement is easily made.

In the lower grades hygiene need not be introduced as a separate study; nor do the younger pupils require a special text-book. Talks on the subject may be best combined with reading exercises, proverbs and riddles, and with occurrences and observations, such as the cleaning of shoes before entering a room, ventilation, etc. Exercises of this kind have been introduced into Austrian readers; collections of lessons have been published also. The study of hygiene at this stage includes cleanliness of body and clothing, habitation, air, light, artificial light, and heat, together with attendant danger of food and eating (moderation), drink (water, its impurities, filtration, alcoholic mixtures), position, care of the organs of sense, and contagious and infectious diseases (preventives). A comprehensive but concise programme is desirable for the teacher.

In advanced grades the above-mentioned subjects may be treated more fully and supplemented by new topics, as: First help in cases of accident (lessons given in Austrian schools), hygiene as regards labor and workshops; instruction on the choice of a calling with reference to health and physical adaptation; even the first steps toward the understanding of social hygiene may be made. Pupils of the highest grades may be taught that the beneficial results of some public measures are felt by those not immediately affected by the regulations. Children from 12 to 14 years of age are able to understand that they incur personal risks by living near those who expose themselves to the danger of infectious diseases by dwelling under conditions unfavorable to health. They can also begin to appreciate the advantages of clean streets, pure water, and the like.

Teachers should not confine themselves to the lessons provided in the readers, but should make use of brief written exercises by the pupils on topics already discussed, compositions on their daily outdoor work and home surroundings, supplemented by discussions and final readings from their own compositions. A catechism of hygiene, with blank pages for remarks, may be given out. Charts of hygienic text (not anatomical pictures) may be hung up in schoolrooms, as has been done in Rome and Vienna. Finally, the course of study in outlines may be given to pupils, with brief explanations to be analyzed by topics. Household hygiene, and that of nursing children and the sick, are particularly significant subjects for girls in the higher grades of common schools.

Elementary schools are made use of, to greater or less degree, for the dissemination of hygienic knowledge in most civilized countries, as the Argentine Republic, Austria, Belgium, Denmark, England, France, Germany, Japan, Norway, Sweden, Switzerland, the United States of America, and others. As a matter of course, the results of efforts in large cities are more conspicuous than those in the States taken as a whole (notice Munich and the State of Bavaria). The thoroughness and the mode of instruction can not be conclusively judged from the reports, which claim to offer only the generally accepted regulations.

I shall say little of what has been done in the separate states, as von Fodor, Kuborn, Layet, and Gauster have discussed hygienic instruction before an international congress, and explained the conditions and progress in their native StatesHungary, Belgium, France, and Austria.

Much has been done in the United States for the study of hygiene, and especially for the prevention of the spread of alcoholism, by the Federal statute of May 20, 1886. Mrs. Mary H. Hunt, who has published and edited works on this subject, was very prominent in the agitation against alcoholism, and gave a very strong impetus to it by incessant and indefatigable efforts. Vermont was the first State to require instruction in "physiological temperance" (1882); now all States and Territories of the Union, excepting Arkansas, Georgia, Utah, and Virginia, have a temperance education law, which requires instruction in the danger of alcohol. In many States, among which Connecticut, Massachusetts, New York, Ohio, Pennsylvania, and others are specially conspicuous, this instruction is neither confined to elementary schools, nor limited to narcotics and stimulants.

Greater efforts in behalf of disseminating hygienic knowledge in elementary schools have lately been made in England, where, since 1896, a series of hygienic subjects has been inserted by law into the curriculum of the national or board schools. In a few selected schools for girls in London domestic economy, with accompanying hygiene, has lately received special attention.

France has recently begun to make use of schools as a factor in the suppression of alcoholism. In pursuance of the report of the commission specially appointed for this work, the minister of public instruction has published a detailed plan of study for elementary and higher elementary as well as for normal schools.

The decrease in the quantity of alcohol consumed per head and per year in Norway and Sweden shows encouraging results. The effect of temperance unions will be discussed later on.

A chief condition for the dissemination of hygienic knowledge in elementary schools is the corresponding preparation of young teachers, which should extend to the fundamental features of general and personal hygiene, school hygiene, and the first aid in cases of accident. With women teachers special attention should be paid to household hygiene, the hygiene of nursing children, the sick, etc. The teachers, in turn, should deliver similar tracts to mothers when their daughters leave school, or even earlier, if girls show unusual physical development. Finally, it is desirable that those in charge of kindergartens be likewise instructed.

Only teachers who have been thoroughly prepared—that is to say, who have themselves been properly taught at a normal school-are able to teach children hygiene. It is a well-known fact that, with a few notable exceptions, teachers who have not received this technical or professional instruction are ignorant of the simplest laws of either practical or theoretic school hygiene. Every country that exacts compulsory education is naturally bound to maintain the laws of school hygiene.

The opportunity of taking a special course-during vacation, for instance-should be offered to all teachers in office who have not studied hygiene. Great success, however, must not be anticipated, though anyone aspiring to the position of school principal ought, at least, to pass an examination in school hygiene. Self-instruction is commendable, even though it can not replace oral instruction accompanied by demonstrations. For this purpose a short, general treatise is to be recommended, not to mention the numerous compendiums published. Teachers should combine their forces against alcoholism, which has its own literature. Teachers, moreover, can exert a beneficial influence upon communities, since in countries of higher culture their profession is considered honorable, and they are oftentimes members of local boards of health.

Notwithstanding the long-recognized necessity, hygienic instruction of candidates for teachers' positions leaves much to be desired. It is seldom well regulated.

1 The Federal law applies only to the District of Columbia and the Territories.-Translator.

2 The legislature of Virginia is now (February, 1898) discussing a bill to that effect.-Translator.