the method of communication, as in the case of the fancied inviolability of telegrams, or upon more plausible grounds of analogy to common law exceptions, should be carefully watched by the courts. Yet, when the exemption rests upon something tangible, as in the case of a statutory provision, the courts are bound to consider the intent of the legislature and to apply well settled rules of construction, True, in the statute, we are not authorized to insert the word "oral" before the word "information," so as to make the words read "concerning any oral information," etc. Information may be communicated otherwise than by the voice; and the patient, who being urged by his necessities, exposes parts of his person where a secret disease lurks, is certainly entitled to the protection of the statute, unless for the purpose and intent of the legislature we are to substitute the immaterial accident of vocal communication. It is the acquisition of information through the medium of professional attendance that is the essential thing. When the patient submits his person to the physician, no word may be necessary, and if necessary this makes no difference, since in both cases the information is acquired from the patient. It is only when the information is such as is apparent on that casual inspection which any one might make, without disclosure of any kind on the part of the patient, that it can be fairly said that there was no information acquired from the patient under the conditions expressed in the statute. All the words of the statute must receive their due force, and that construction is worthless which disregards the peculiar significance of the word "information," and refuses to give any meaning to the phrase - peculiar to the statute and inserted doubtless ex industria "from the patient." ** It is a direct violation of the statute to say that a physician, because he has attended a patient shall not testify at all. It is the relation of physician and patient that is the reason and the basis of the whole exclusion; and the bridge ought

* *

not to be broader than the flood. When

this relation is not involved and the burden is on the objector to show that it is the first condition is not met. What occurs outside that relation, or before the patient submits himself to the physician, or the latter addresses himself to his duty; is not excluded, else the basis of exclusion would be altered and the statute extended. Thus, objective signs, which are obvious on such an observation, as implies no disclosure - symptoms which are apparent before the patient submits himself to any examination - the statute gives no authority for excluding. That a patient had an inflamed face, a blood-shot eye, that fumes of alcohol proceeded from his person, that he talked deliriously, could be excluded only on the basis that the statute forbids a physician to be a witness. These objective signs, and others which imply no knowledge obtained as the result of submission or exposure by the patient, and which would be apparent before the initial act of service on the physician's part, the latter should testify to under our statute. It is not an objection to this view that the trained eye of a physician might thus detect sure signs of the existence of a given disease. Nor is it an objection that the witness would be required to acutely discriminate as to the sources of his knowledge. The statute is not to be interpreted wrongly, because there is a difficulty in applying it rightly.

So that physicians need have no hesitation in pleading privilege on the witness stand. Though this privilege is of comparatively recent origin, its wisdom being so readily perceived, it is gaining ground in the courts every day, and doubtless the rule expressed in the New York and Missouri statutes will be found in every statute book in the Union. It alike protects patient and physician.

ORIGINAL ARTICLES.

SCHOOL HYGIENE.

BY H. R. GUTHRIE, M. D., SPARTA ILL.

Read before the Southern Illinois Medical Society, June 17th, 1886.

The prevention of disease is the line of thought in which there is the greatest activity, in the world of medical as well as the scientific literature of today. The medical profession of today not only embraces in its range of vision the study of the means of alleviating pain and suffering, but goes one step farther, and inquires into the causes of disease, and as a natural corollary, the removal or prevention of the causes. Scientists and philanthropists have given much time and thought to the study and discussion of sanitary matters, each one in his or her special sphere adding their mite to the grand whole. Many, not only in but out of the profession, whose names have not appeared as champions of the cause, are closely scrutinizing everything which has a bearing on the health and lives of the community. The universality of interest arises from the fact that all classes and conditions are to a greater or less extent influenced for weal or woe; this appeals to us to give the subject a calm and dispassionate consideration, and not to pass it over lightly as a matter of routine to never be thought of again.

The special subject which I have chosen for a short paper is School Hygiene. This is a subject which should and does interest every member of society, whether lay or professional, as every man, woman and child should be interested in schools. In a few short

years the boys and girls of today, will be the men and women, on whose shoulders will rest the responsibilities of the public and private affairs of our country and in proportion as we discharge our duty,will they be prepared to meet their obligations.

The old Latin maxim, "Sana mens in sano corpore", is as true today as when first penned. An active energetic working mind must have a sound brain as its home. No creaking or decrepit machinery is capable of producing as much power, or as good results with the same amount of power as that which is produced by machinery in good working order. The brain is the organ through which the mind acts, if it is unhealthy you will do poor mental work.

The inter-dependence of all the organs of the body is so great that if any one of them is disordered, all are more or less affected. That we may be able to attain the greatest activity, all must be within the line of health, so that they may all act in harmony. You cannot have an active, well regulated brain with defective digestive organs, as it is through this apparatus that the materials for growth and repair are received. These may be in good condition, doing their part well, and a good supply of food; but if the circulatory apparatus fails in distributing the supply which is furnished, growth and repair will not take place, starvation will follow as certainly as if the supply of food was nil or scanty. Again if the excretory organs fail to perform their part, the effete matters remain in the system to not only mechanically interfere with the function of the organ where such effete matter remains, but it takes on a new role, yiz., that of an active poison which sooner or later will destroy life. From this short sketch of the functions of a few of the organs of the body, we can readily see the necessity of a healthy body to have an active mind; and just in proportion as we have this health, other things being equal, will we have the highest type of mental activity.

A pertinent question for us to consider is how can the best results be attained under our present school system? The answer to this question naturally divides itself into three parts.

1st. The hygienic condition of the school house.

2nd. The physical and mental condition of the scholars.

3rd. The physical condition as well as the mental aptitude and acquirements of the teacher.

As the age of the persons for whose benefit the school house is intended, favors rapid absorption and the susceptibility increased by being in a more or less vitiated atmosphere which lessens the power of resistance, the danger is greater from unhealthy surroundings, than it is in adults. A healthy locality is the first requisite. Contiguity to marshes or other noxious material which may vitiate the atmosphere, should be avoided.

Sun-light, according to Lincoln, in "Buck's Hygiene and Public Health," is the second requisite. The house ought to be so arranged that every room should receive the rays of the sun some part of every day in the year; nothing like verandas or shade-trees, however pleasing to the eye, or comfortable, should be allowed to interfere with the healthfulness of the building. The only exception the au

thor above refered to allows, is in the more southern latitudes.

Dry cellars are of supreme importance, and where they cannot be kept dry, better far to do without them. In Southern Illinois, the character of the subsoil is such that it is almost impossible to have a dry cellar.

The lighting of the room should receive more attention than it does. The pupils ought not to sit facing the light, nor should they sit facing a white wall; but the wall should be of some neutral color, such as neutral gray or light green, with a white ceiling, as the white reflects more and a better quality of light. Nearsightedness according to Donders is essentially a disease of childhood. He says that he has never seen a case originate after the age of twenty, while others say fifteen. This is very suggestive that the amount and the quality of the light at home and in the schoolroom, are the active factors in producing this disease.

Drainage is a matter which should not be overlooked. Lincoln in the article on School Hygiene above refered to says "that it is necessary to condemn the common privy as dangerous to the health of scholars. In country schools they are seldom if ever cleaned out." If nature has provided a small rivulet on any part of the grounds, which is dry except during a shower of rain or for a short time after it, the privy is placed over it, with the hope that the heavy rains will come often enough to wash them out, without much regard as to where the excreta is carried. This neglect of the plainest sanitary measures has made it not only disagreeable but dangerous to live in the proximity of places where large numbers congregate, and particularly where there is no system of sewerage properly arranged and carefully watched. Earth closets would abate this nuisance.

The last but not least of the topics under this head is heating and ventilation. The amount of heat to make children comfortable is not a fixed factor, and it is one for which it is difficult to fix a standard; as we have children in robust health and well nourished sitting along side of those who are feeble and ill nourished, again those who are well clad and the opposite, those who are accustomed to superheated houses, and those living under opposite conditions, all classes and conditions with their opposites are thrown together. Americans prefer warmer rooms than that which is agreeable to Europeans. Authorities differ greatly as to the amount of heat necessary. Morin's maximum is 59° for schools, Varrentrapp's is 653° F. to nearly 80° in America.

The temperature of our school-rooms is often regulated by the feelings of the teacher, a false guide. A teacher, young, in robust health and well clad, and whose duties require him or her to move about in the room, may not require the amount of heat for an ill clad and poorly nourished child, who is required to keep its seat; while on the other hand the teacher may be advanced in years, poorly nourished, requiring a higher temperature than is requisite for the scholars. The only safe guide is the thermometer, and that should be directed by the board of health in localities where there is one, provided said board has a sanitarian on it.

The kind of apparatus for heating should not be overlooked. There are many objections to the use of stoves, and where they can be discarded ought to be; hot water seems to be the least objectionable, then steam and hot air; these should be connected with a system of ventilation, and that should be of power sufficient to supply plenty of good air without creating a draft. The problem of ventilation is fraught with many difficulties, and in proportion to the number of stories in the building the difficulty is increased. The source of the fresh air is a desideratum; it should never be taken from the cellar, nor from localities contaminated with any foreign product. The amount of fresh air required in any given room will depend on the number of occupants. A school house having many rooms well filled, soon has an odor peculiar to itself, and will soon become markedly unpleasant, as well as injurious, if care is not taken to open up the rooms when not occupied. In large cities the difficulty of getting air uncontaminated is much more difficult than in smaller towns and country; and on account of the difficulty of ventila ting large buildings, where the cost of building sites is not too great, it is better to have more, and less in size. Too many children ought not to be congregated in the same building. Pure air is a requisite of good health, the farther you get away from this you increase the liability to disease, and if disease is not generated, vital vigor is lessened and the capacity for mental labor is lessened.

The difference between a well heated and ventilated school-room and one poorly arranged would be hard to compute. A little education with a vigorous system is worth more than a liberal education, with a shattered constitution. Without good hygienic surroundings the scholar will not long be able to do full work nor that work well.

The second proposition viz., the physical

and mental condition of the scholars presents a number of points worthy of consideration. Children should come to school clean and neat, hair combed, feet cleansed SO that nothing will be added to the contamination of the air of the school-room which can be avoided. This is not only beneficial to the general health, but is a good lesson to the individual scholar. Many come from homes where such lessons are not as strongly inculcated as they might be. Poverty is not a crime, no matter how inconvenient it may be; but the addition of filth, if not a moral, is a physical crime, which sooner or later is visited with a penalty. The scholar should not only be clean and neat, but free from contagious and infectious diseases. Where so many children are assembled, as we find in our graded schools in our towns and cities, and even in the country, it becomes necessary that constant vigilance, on the part of school authorities, should be exercised so that these places will not be foci from which disease will be disseminated.

There is no difference of opinion in relation to the contagiousness of small-pox. The public run to the extreme in their demands for protection against this, while others equally as deadly, if not so loathsome, with far greater danger from the sequelæ, are not so carefully quarantined; among these I may mention scarlatina, measles, diphtheria, typhus and typhoid fever and tubercolosis. The last named is not considered infectious by all the medical profession; but the belief of its contagiousness is fast gaining ground among those of studious and observing habits. We have one writer, Waldenburg, as quoted by Booth in his address, when President of this Association, who goes so far as to say that it ought not to be classed with the ordinary infective diseases, but placed along side and classified with glanders, one of the most dangerous maladies known. It is a debateable question at what point scholars suffering with this should be prevented from attending school. If we believe with Zenkevitch that the production of disease germs "is proportionate to the degree of fever, which depends, also, upon the rapidity of the destructive lesions of the disease" [Quarterly Compend. Medical Science, April 1886, page 199]; then it will be time for school authorities to take action, if not prior to this. Usually before the disease reaches this point the scholar ceases to attend. School boards and health boards ought to consult with one another so that they may act intelligently and for the good of all.

The following quotation from Public Health,

date July 26, 1879: "It seems axiomatic that medical inspection will rapidly and greatly prove effective in improving the health of children. To attempt to demonstrate this would require us to prove that the medical profession understand their business, and can attend to disease and can detect premonitions of disease with better hope of care and prevention, than those who have had no special preparation. We must be allowed to insert here an expression of our opinion, that medical training is incomplete without an extensive study of sanitation."

"The present school management entrusts the sanitary and medical inspection to the teacher, to the school director, or to nobody, the latter to be preferred to the others, since the sins of error are not to be added to those of neglect, with such supervision. In either case the work is neglected, or imperfectly, however ostentatiously, done, since farmers, lawyers, or merchants can no more effectively take the place of a physician, than a bricklayer or the baker. There is no such things as medical inspection of schools at present, as school reports conclusively show.

Seeds of disease are sown broadcast in the school, and the fact is discovered, when the register of attendance shows a considerable absence due to sickness."

In another section of the same article we find the following: "Schools must be changed from pest nurseries into model sanitary conveniences; their sanitary standing must surpass that of home. This can be accomplished by well paid, effective, regular medical inspection, and by no other means."

In looking at the physical sanitation we must not neglect the mental. Scholars come from the homes of the affluent and the hovels of the poor and degraded, from the homes of refinement where knowledge is appreciated and where the children are surrounded with influences which assist and give a stimulus to the student; while many from the other walks of life have hindrances in place of assistance. Some of them from the want of thought, or the realization of what is advantageous, or it may be from necessity that their time is occupied in doing chores, which ought to be occupied with their books.

So far, we have supposed that all are on a par as to mental capacity; this assumption will not do, as we find as much difference in the mental capacity as we do in any of the surroundings. With these differences the scholars appear in the school room to be classified, this is no easy job, to do justice and not appear to act partially. As soon as the school is fairly started, those who are

by nature and circumstances the more highly favored, take the lead, but no matter how far they may lead, they are kept in the same class, and not allowed to make any greater advances than those who have less favorable surroundings. You have in every class of any size three grades of scholars, those who have taken the lead, those who make fair recitations and those who are a clog to the rapid progress of the class, from the want of ability or some cause interfering with their studies. The teacher is not to blame, the fault lies at the door of the graded system, in attempting to force all of every grade into the same mould.

There is one class whose special condition is not taken into account, although warning has been given by such men as Emmett and Goodell, with others, and that is young girls from the age of thirteen and fourteen to sixteen or seventeen, during the time the menstrual function is being established. This takes place when growth is rapid, and the tissues soft so that they are unable to bear a severe strain; add to this the periodic loss, with the disturbed condition of the nervous system with very many at that period, and you have the condition of the average American girl at this age. The margin of vital force left is not enough to furnish brain power to carry the studies demanded, and the result is an injured nervous system, which continues through life. Parents and teachers should be instructed as to the liabilities of this class at this age; and when symptoms such as these present themselves, viz: listlessness, headache, tremulousness, more easily startled by any unusual sound, irregular appetite, constipation, etc., it is high time that the pupil be taken from school, or the amount of labor brought within the capacity of the scholar.

Our present system of graded schools, where a certain amount of work is allotted to a certain time, without taking into consideration the physical or mental capacity of the pupil, is as absurd, when studied in all its bearing as the ingenuity, or want of ingenuity, of man or woman can invent. If a scholar of good physique, active and energetic, with good mental capacity, and whose surroundings are such as to give assistance, is ready to pass from one room to another; he or she should not be kept back because the rest of his or her class is not ready for promotion; and, on the other hand, if they are not prepared, even if the allotted time has been filled, they should not be promoted. An injury is inflicted in either case. A premium should be offered for honest, energetic work, not machine work.

In this way mental hygiene can be improved, minds strengthened and energy infused, which can never be done by ironclad rules, such as are in existence to-day. I do not wish to be understood as saying that I am opposed to our present school system, but as a friend, pointing out its defects, so that they may in time be remedied.

The third and last division of our subject, viz., the physical condition, as well as mental aptitude and acquirements of the teacher. In discussing this part of the subject, it is well to bear in mind the class for whose benefit schools are created. They are not, and ought not to be considered eleemosynary institutions or health resorts, the ranks of whose teachers are to be filled from those in need, or failures in other walks of life. The teachers ought to have an aptitude for teaching, with the neces sary training and a healthy, physical organization to enable them to utilize their faculties. All the precautions which are necessary in relation to contagious and infectious diseases with the pupils, are more necessary with the teacher on account of the different relationship to the school. The teacher should be bright, cheerful and energetic, as scholars imbibe much from their teachers, imitating them in manners and movements.

A teacher who is under par, caused by disease of any kind, is incompetent to impart instruction in a manner which will make much impression, and fail, by their listlessness and want of energy, to arouse in their pupils that enthusiasm which is necessary to success. Add to this contagion or infection, and you have a still stronger objection.

Among the list of diseases, with which school teachers are likely to be affected, are consumption and catarrhal troubles, which frequently are forerunners.

The doctrine of the contagiousness of consumption is not of recent date. Clapp, in his work, "Is Consumption Contagious?" refers to Aristotle and Hippocrates before the Christian era. One extract which he quotes from the former says that "it makes the breath corrupt and offensive, and those who breathe it suffer." Galen, A. D., 180, uses the following language: that it is "dangerous to pass the whole day with a consumptive person, and with all people whose diseases generate putrid effluvia." In the same book I find the following quotation from Richard Maston, 1697: "A contagious principle also propagates this disease, for, as I have often found by experience, an affected person may poison a bedfellow by a kind of a miasm like that of a malignant fever." Among others the names of Valsalva, Morgagni and Andral