Essays In Pastoral Medicine Part 19

Ages Hours of work a week

From 5 to 6 6 6 to 7 9 7 to 8 12 8 to 10 15 10 to 12 20 12 to 14 25 14 to 15 30 15 to 16 35 16 to 17 40 17 to 18 45 18 to 19 50

Work given for punishment must be included in these hours. No one, even an adult, should study for more than two hours at a time without an intermission for a few {205} minutes. In a boarding-school no one under any pretext, even on rainy days, should be permitted to study during recreation hours, and the deprivation of recreation to make up lessons is a relic of barbarism. If a teacher can not get cla.s.s work done except by shutting up children during recreation hours, remove the teacher or expel the pupil.

The amount of glazed window surface admitting light to a cla.s.sroom or study-hall should be from one-sixth to one-fourth the floor s.p.a.ce of the room, and this must be increased if the light is obstructed by neighbouring houses or trees. The light is to be admitted on the left side of the pupils,--all other windows should be counted as ventilators only. Windows facing the children or the teacher are to be avoided. In rooms fourteen feet high a desk twenty-four feet from a window is insufficiently lighted. The larger the panes of gla.s.s the better, and the external appearance of windows is to be sacrificed to good lighting. If screens are used to protect the gla.s.s from stone-throwing, allowance is to be made for the light the screens cut off.

If a room can not have enough light from the left side alone, put the additional windows on the right so that their lower sills will be eight feet from the floor; and be careful in this case that the light from the right is not brighter than that from the left.

Windows should have as little s.p.a.ce as possible between them to avoid alternate bands of shadow and light. Set them up as near the ceiling as possible, since the higher they are the better the illumination; and they should not be arched at the top. The lower window sills may be about four feet from the floor. When window shades are used to cut off direct sunlight, they should be somewhat darker in colour than the walls.

If artificial light is used in boarding-schools in the study-halls, the best light is one that is as near in colour as possible to the white light of the sun, and ample, but not glaring. It should be steady, and it should not give out great heat nor injurious products of combustion. Hence the electric light is the best; after that, gas through Welsbach {206} or Siemens burners. Well refined kerosene oil gives a good light, but it is always dangerous. Acetylene gas is now used in a safe apparatus, and it also is an excellent light.

No colour that absorbs light should be used on the walls. Pale greenish gray, nearly white, is the most satisfactory colour. There should be no wall paper, curtains, or hangings of any kind in a school or college building. The wall decorations should be as plain as possible, with no roughened places to catch dust.

Stairways are to be well lighted; they should be at the least five feet wide, and have landings half-way between each story. Diagonal or spiral stairways are dangerous. Steps with six-inch risers and eleven-inch treads are the easiest for children, but six-and-a-half-inch risers may be used in high schools and colleges.

Carbonic acid in the air of a cla.s.sroom is an index of impurity.

External air has about three parts of carbonic acid in 10,000 parts of air, and above seven parts in 10,000 is injurious. Each person exhales about fourteen cubic feet of carbonic acid gas in an hour. There is no easy method of determining the quant.i.ty of carbonic acid gas present in a room, and we must therefore arrange the ventilation so that about 3000 cubic feet of fresh air an hour will be supplied to each person in the house.

Beside carbonic acid there are other impurities in house air, as dust, micro-organisms of disease, exhalations from bodies, sewer gas, and the like, which acc.u.mulate and do injury when the ventilation is defective.

If every person in a house has 1000 cubic feet of air s.p.a.ce, natural ventilation will suffice ordinarily, but artificial ventilation is needed in schoolrooms and dormitories. The subject of ventilation can not be satisfactorily discussed in a short article, and those that are interested in school building should leave the matter to a competent architect, or study books and articles like J. S. Billings'

_Ventilation and Heating_, Pettenkofer's _Ueber Luft in den Schulen_, and Kober's article on House Sanitation in the _Reference Handbook of the Medical Sciences_.

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The proper heating of a schoolroom is a matter so generally understood that there is no need for special remark here, except this, that provision for proper humidity in the heated air is commonly neglected.

Cheap water-closets do not save money--they get out of order too easily. The pan, valve, and plunger hoppers are not to be tolerated.

The only kind to use are short-hopper closets with a trap that opens into the soil-pipe above the floor. These may have valve-lifters attached to the seats, because children forget to flush the hoppers.

The ventilation of the water-closets should be separate from that of the main building. In country places where vaults are used, there should be a supply of dry loam kept, and enough of this to cover the fresh contents should be thrown into the vaults every evening.

Children are seemingly always thirsty, and they should be allowed to have all the drinking water they want if the source is free from typhoid germs and infection by organic matter. Common cups are an abomination, and a prolific cause of contagious diseases. Each child should have its own cup.

The rules for desks and seats for children are these:

1. The height of the seat should be about two-sevenths of that of the body.

2. The width of the seat should be about one-fifth of the length of the body, or three-fourths the length of the thigh. Do not keep unfortunate little children's feet dangling all through their school years to save a few pennies on school furniture.

3. The seat should slope downward a little toward the back, be slightly concave, and have rounded edges in front.

4. There must be a back-rest.

5. The child, when sitting erect, should be able to place both forearms on the desk without raising or lowering the shoulders. This is a very important rule.

6. The seat must be correctly placed as regards the distance of its front edge from the corresponding edge of the desk.

7. The desk slope should be 15 degrees.

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Badly constructed desks cause eye-strain and marked distortions of the spine. Desks should be adjustable in height, especially for growing children. School-children grow most rapidly between the ages of twelve and sixteen years--nearly two inches a year--and the desks and seats should be adjusted twice a year at the least. If a child is moved to another desk an adjustment is to be made at once.

To counteract the bad effect of long sitting, even at properly adjusted desks, children should be frequently sent to blackboards, and at regular intervals a few minutes are to be given to "setting up"

exercises.

Great attention should be paid to the eyesight of children. Those that complain of headache should have their eyes examined. The lines in school books should be not more than four inches in length, and they are to be printed in clear, well-leaded type. Slates are dirty and unsanitary: let the children write on paper that has a dull finish.

Teachers should prevent lounging positions at desks, especially stooping. They are not, however, to try to make children under fifteen years of age sit still. The youngsters can not remain immovable, and the effort to make them do so is irritating to no purpose.

Nervous children need outdoor exercise more than anything else. When nervousness takes the form of religious scrupulosity in school-children and novices do not immediately apply a moral theology to them--call in a physician that has common-sense, because there is a nervous scrupulosity which is much more frequently met with than the purely spiritual form. Aridity in prayer, a loss of sensible devotion, and similar troubles have to do with advance in the spiritual life, but they more commonly have to do with the liver in persons that are not nearly so important spiritually as they fancy they are; and in these cases the cook is the particular devil at fault, if they have exercise enough.

One of the chief sanitary evils in our boarding-schools, convents, and similar inst.i.tutions, is the stupid sameness in the food which may be otherwise un.o.bjectionable. The meat, for example, may be good, but the college and seminary cook sends it into the refectory chilled and clammy, or hot and overdone. In any case it is everlastingly the {209} same. Children can predict a dinner's ingredients a month in advance.

Give children meat twice a day; white flour in their bread, because it is digested better than whole flour; all the sugar they want at meals; milk rather than tea, and tea rather than coffee; but let it be tea, not a dose of tannic acid.

The physical education of girls is neglected. Their general education is effeminate rather than feminine. If a convent faculty grows bold and "modern" it hires a teacher of gymnastics, puts an "extra" on the bill of expense, and ten or twelve wealthy girls play at gymnastics if they are not too lazy. Even if the whole school is obliged to attend the club-swinging and posturing and the other nonsense, little good is done. Girls should be kept out of doors for their exercise, and fresh air is much cheaper than a gymnastic teacher. If school-girls were forced into the open air more, they would not have time for munching caramels over the erotic spasms of Araminta and Reginald in the popular novel, and there would be advantage in the change. The absence of daily, regular, and sufficient exercise renders girls listless, anaemic, sallow, foul-breathed, melancholy, stooped, irritable.

Do not permit boys under eighteen years of age to go into regular training for college track-teams. Their hearts are not strong enough for the strain.

Boys should not use tobacco in any form, but it is useless to try to make them believe this statement. Tobacco stunts a boy, causes dyspepsia, and renders his mind dull. The measurements made for years at Yale, Amherst, and other colleges, by physical directors, show remarkable reduction in the height and chest expansion in tobacco users as compared with boys that do not smoke. Cigarette smoking would not be different from other smoking if it did not so readily tend to excess. Cigarette smoke is inhaled more than the smoke from cigars and pipes, and thus more of the injurious ingredients of tobacco are absorbed.

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If a boy will smoke let him use a good long-cut tobacco which has little or no Perique tobacco in it, in a "Remington," "Edison," or similar wooden pipe. These are pipes with stems of large calibre, and in the stem there is a roll of absorbent paper or pith which keeps the pipe clean. Cigars, no matter how costly they may be, are too strong for a boy and for most men. A poor cigar irritates the throat aside from the regular effect of the tobacco, especially if there is much nitre in the wrapper. Meerschaum pipes are dirty and too strong. The tongue is irritated by a pipe that has a small bore in the mouthpiece: use a mouthpiece that has as large a bore as possible. Cigar smokers should, after cutting off the end of a cigar, blow the dust out of it from the lighting end to avoid inhaling this irritating dust.

AUSTIN oMALLEY.

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XVII

MENTAL DISEASES AND SPIRITUAL DIRECTION

It is a well-recognised fact that persons suffering from many forms of beginning mental disease are likely to be affected by an exaggeration of religious sentiment. An unaccountable increase in piety is sometimes the first warning of approaching mental deterioration. It is not hard to understand why this should be, since religious feelings occupy so prominent a place in the minds of the majority of people, and the removal of proper control over mental operations of all kinds leads to an exaggeration, especially of those that have meant most for the individual before. Supposed religious vocations, especially when of sudden development, are sometimes no more than an index of disturbed mentality. Every confessor of lengthy experience has had some examples of this. This makes it important that clergymen should have a knowledge of at least the first principles on which the diagnosis of mental diseases is made. Superiors of religious communities, and especially those that have to decide as to the suitability of those applying for entrance to, or already in probation for, the religious life, need even more than others a definite knowledge of the beginning symptoms of the various mental diseases, and of the types of individuals that are most p.r.o.ne to suffer from them.

Besides, confessors and religious friends and advisers often gain the confidence of the mentally diseased much more fully than any one else.

It is to them especially that the earliest symptoms of beginning mental disturbance are liable to be first manifested. After all, a pastor's and a {212} confessor's duty is bound up with the welfare of his spiritual children in every sense; and it would be supremely serviceable to the patients themselves and to their friends, if these earliest symptoms could be recognised and properly appreciated, and due warning thus given of the approach of further mental deterioration.

The mental diseases that are of special interest in this respect are the so-called idiopathic insanities. Idiopathic is a word we medical men use to conceal our ignorance of the cause of disease. Idiopathic diseases are those that have come of themselves, that is, without ascertainable cause. As a matter of fact, the most important group of mental diseases develop without presenting any alteration of the brain substance, so far as can be detected by our present-day methods of examination. The initial symptoms of these diseases, then, are of great importance, and not readily recognisable unless looked for especially. There is no physical change to attract attention, and the change of disposition and mental condition is often insidious and only to be recognised by some one who is in the confidence of the patient.

It is in these idiopathic insanities, then, that the careful observation of the clergyman is of special significance. Needless to say, powers of observation to be of service must be trained.

While there are no known changes in the brain tissues in these diseases, it seems not improbable that the development of our knowledge of brain anatomy, which is especially active at the present time, will very soon demonstrate the minute lesions that are the basis of these mental disturbances. It seems not unlikely that the underlying cause of so-called idiopathic insanity is usually some change within the brain cells. Hints of the truth of this conjecture are already at hand. Meantime the actual observation of this cla.s.s of patients in asylums and inst.i.tutions, private and public, and the collation of the observations of authorities in psychiatry from all over the world, have thrown a great deal of light on these forms of mental disease. We know much more of the initial symptoms and of incipient conditions that threaten the development of mental {213} disequilibration than we did twenty-five years ago. With regard to prognosis especially, recent publications have added considerably to our knowledge, although it must be confessed that they have rendered our judgment of such cases much less hopeful.