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Report of the Medical Officer (Education).
169
The first type of children is roughly represented by those now sent to the existing open-air school.
It would include sufferers from anaemia, malnutrition, and general ill-health, as well as many suffering
from early stages of tuberculosis of glands or lungs. The latter group of lung cases would not include
those who cough or expectorate, who, if such symptoms appear, would be deemed to be infectious,
and therefore would be removed from school as invalid.
The second type are children definitely proved to have tuberculosis, but at such a stage that
residence not exceeding a year might be expected to result in a "permanent cure." This group
would include all forms of tuberculosis not calling for such medical treatment as would exclude schooling
under special conditions. Some would have early or temporarily arrested joint or bone diseases, others
glandular or pulmonary disease in quiescent forms. It would be impossible to assume that the last
would remain without cough or expectoration, or discharges which might contain infective bacilli, so
that for this class of child it would be necessary to provide all the routine for avoiding infection and
means for facilitating sterilisation of materials and constantly watching all sources of risk.
The provision for tubercular children would depend on how the groups as shown above were
defined.
The first-class—A residential open-air school for say 120 children of the type now admitted to the
existing open-air schools.—It is assumed that any child showing signs of disease involving risk of
infection would be sent home at once.
A moderate-sized site, of two or three acres, would suffice if in the neighbourhood of common
or other accessible open spaces.
Adequate space for outdoor classes and partly covered, in case of wet weather, would be necessary ;
Doecker sheds would suit.
For teaching certain subjects and for use in constantly wet weather some well-lighted and fully
ventilated classrooms should be available, but used as little as possible. The classrooms should be
so desked that they can be used for recreation on long dark winter afternoons or in the evenings. A
portable type of school desk available for in or out door is to be recommended.
A separate dining hall is necessary both on hygienic and administrative grounds. An assembly
hall, available also for recreation, will probably be required. A suitable boot room near the entrance
and apart from the cloakroom and a place for drying wet clothes must not be overlooked ; this will
save labour in cleaning and reduce dust. The bedrooms could be on upper floors, should be large and
well ventilated. Sanitary accommodation, accessible at night, is required, and spray or other baths.
The staff bedrooms may be placed where most convenient for supervision of the children, as there will
be no risk of infection. The resident staff would probably comprise teachers, domestics, needlewoman,
and at least one trained nurse.
Questions of water supply, lighting, heating, sewage and provision of a laundry depend on
local considerations. Steam heating has been found the most dependable and simplest in sanatoria.
Sick room accommodation for the instant isolation of any infectious case must be provided.
The medical inspection could be carried out weekly by arrangement of the Council's permanent
staff, whilst urgent calls might be dealt with by a local doctor.
Provision of a residential school for the second class of definitely tuberculous children.—When a
community is to consist entirely of tuberculous children the question of infection and of the care of
the individual becomes urgent and requires modification of the plans required for ordinary open-air
schools, residential or not.
(i.) Infection.—The risk is solely in discharges from the patient. Dressings would have to be
collected and burned, the vessels in which they are received being subsequently sterilised. Children
with cough and expectoration would have to use spitting flasks, which must be collected, cleansed and
sterilised twice or thrice daily. The contents must be sterilised before being discharged into the drains.
Sterilisation of linen, bedclothes, and handkerchiefs would be necessary. The need for sterilisation
is imperative, but its cost is not great if steam heating for cooking or the laundry is provided. The
local authority may be expected to intervene if sputum or washing water from linen is discharged
unsterilised into the drains.
(ii.) Individual care.—These patients are liable to sudden relapses or complications. These
may be avoided often by instant attention to the first trivial signs. These cases, in a day school,
would be kept at home for a time, and not become obvious, but in a residential school, especially in
pulmonary cases, they must be provided for and guarded against. During the earlier part of their
stay temperatures ought to be taken, at least four times daily. Few children would be likely to be
affected acutely at one time, but in their earlier weeks all should have the most constant medical and
nursing supervision.
(iii.) Site and Structure.—The grounds should be twice to thrice as large as in a school for the
other group, say, at least six acres for 120 children, as supervision is less easy outside, and naturally
objections to "consumptive" children will be raised in the neighbourhood of the school. Provision,
which may not be required often, must, however, be made for a few children to be in bed all day ;
this involves special sanitary arrangements. These particular bedrooms should be readily washable
and on the ground floor, or have balconies so that the cots could be wheeled into the open. More
nurses would be needed, and the staff might require quarters apart from the children, as generally they
are well impressed with the risks of infection.
Daily supervision by a medical officer with special experience of the management of tuberculosis
would be necessary, and all his directions as to rest or play, and the amount of activity allowed
each child should be implicitly followed. It might indeed be advisable to have the superintendent
a medical man.
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