By instructing the teachers on the subject of hygiene, much can he accomplished in the way of correcting defects of vision, injurious atti tildes, and other ills resulting from or aggravated by school work. Such instruction is now being given in many places for both teachers and parents, and these meetings result in the exchange of much useful advice and many helpful suggestions tending toward the improvement of these conditions. In carrying out these measures and precautions it) preserve the health of the child during school life, the physician may rely upon the devotion and interest of the teacher. He must, however, so regulate the time spent. by the child outside of school that there may be a mini of interference with the course of instruction.
To attain this end, the physician should call to his aid all possible hygienic measures. In order that the child may properly perform all its new duties, it is of the utmost importance that its health be kept as nearly perfect as possible, and that its physical strength be developed by exercise adapted to its age and sex, such as skating, exer cise in the gymnasium, play (basket-ball, foot-ball, lawn tennis, etc.) in the open air, and, last but not least, plenty of walking. In order to prevent the tiring of either mind or body, the day's activities should be suitably distributed. The hours of rising and retiring must be caro fully regulated, and ten hours of rest at night should be insisted upon during the earlier school years. It is advNAble, for many reasons, that absolute regularity be maintained in the hours for sleep, permitting no deviation even on Sundays and holidays. With such deviation there develops a tendency to lie awake in the warm soft bed, which frequently arouses erotic sensations and which may finally lead to onanism. It is preferably to be recommended that the spare time of the child be devoted principally to long walks or to some congenial occupation for which there is no time during the week. The day itself, too, should be so divided that there will be regular interchange of work and freedom. In order to insure complete mental relaxation, the periods of freedom should be sufficiently long to permit the taking of walks. or the playing of games.
The nutrition of the child during school years should particularly engage the attention of the physician. It is striking that, just in the early school years, there is a flagging of the nutrition. This may be due, in part. to the fact that the children, being unaccustomed to early rising, laboring under the excitement of an effort to reach school punc tually, and fretting for fear they may be late, cannot eat breakfast com fortably in the time at. their disposal. It is not uncommon to find a
failure of appetite after a time among those young children who go to school without having eaten enough. They do not care for the luncheon they take with them to school, and are likely to partake sparingly of the mid-clay meal or to refuse it altogether. In such cases the physician can enforce prophylactic measures by instructing the parents that it is necessary to insist that the child cat a plentiful breakfast; and by show ing them that the smaller the quantity of food and the less frequently it is introduced into the stomach the less the desire for food becomes, until finally there is complete anorexia; but that after a good breakfast, the child is apt to hunger for luncheon, so that finally the appetite will become normal. The quality of food appropriate for this period should be considered, as well as the regularity of the meals. This should consist principally of fats and carbohydrates, and, in preference to the meat and eggs which the parent is likely to offer under the impression that they contain more strength, the child should receive plenty of fruit and vegetables.
Those children who possess certain constitutional anomalies, or who are delicate or amemic, demand special supervision from the physi cian, so that they may not he harmed by overtaxing their strength at school. Where the strain is telling upon body and mind, the child should be relieved of those studies which are not absolutely necessary for its advancement, such as drawing, manual training, singing, technical branches, etc. This can be accomplished through a physician's certificate as to the necessity for this action. Extreme watchfulness should be given to the work in the gymnasium, and special work in this line should be given to children who have hernia, or a tendency to hernia; and to those suffering from tuberculosis, bone disease, lameness, or fractures, as well as to cases of scoliosis, for which orthopedic gymnastics are required.
But in certain individual cases even relief from part of the school work does not suffice, and it then becomes necessary to discontinue school work entirely, or to give instruction but a few hours daily, either individually or with children of similar limitations. In this direction a brilliant vista opens up for the benefit of sickly children, as is illustrated at the "School in the woods," in Charlottenburg, which has already been taken as a pattern by other cities.