I06 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 63 



The instruction of children at the Sea Breeze Hospital for 

 Tuberculous Children at Coney Island is provided by the Board of 

 Public Education of Brooklyn, New York, and the Board deserves 

 credit for thus cooperating- with the Sanatorium. Provision is now 

 made in the larger cities for the regular and systematic education 

 out of doors of tuberculous children in the community at large and 

 the success of this movement is attested by the fact that on May 

 I, 191 3, there were 177 open air schools in the United States, five 

 of these are in Rhode Island ; thirty in Manhattan ; twenty in 

 P'rooklyn. 



See also Jay Perkins, M. D. : Fresh Air Schools — How They Accomplish 

 Their Result (Journal of the Outdoor Life, New York, June, 1912). 



Les EColes de Plein Air, leur valeur prophylatique dans la Lutte Anti- 

 Tuberculose, "Tuberculosis," Berlin, Nov., 191 1. 



The Open-Air School, Anna Garlin Spencer, Trans. Sixth International 

 Congress, Washington, 1908, Vol. 2, p. 612. 



Open Air Schools, Thomas Wray Grayson, M. D., Therapeutic Gazette, 

 Nov., 1913, p. 27. Also John V. Van Pelt, Interstate Med. Journ., April, 1914. 



In order to control tuberculosis efifectively we shall have to make 

 more determined efforts to reach the school children and even those 

 of earlier years. Tuberculosis is latent in thousands of children 

 in every large city ; sooner or later it becomes manifest as vital resist- 

 ance becomes lowered. A recent view, prevailing in France and 

 Germany, is that all tuberculous infections are made in infancy 

 and childhood, the disease lying- latent, from one cause or another, 

 until the individual resistance, weakened by successive colds, pneu- 

 monia, grippe or other infections, or exposure to reinfection, finally 

 yields and tuberculosis is actively established. Both laboratory and 

 clinical experience point to a much earlier primary infection than we 

 have been accustomed to believe and hence too much stress cannot 

 be laid on the importance of better ventilated schools and the estab- 

 lishment of more " fresh-air schools" in every city of the country. 

 These should be located near parks, if possible, or at least have ex- 

 tensive play grounds.' They should be conducted also for the benefit 

 of children who may be anemic, nervous, and not necessarily tubercu- 

 lous ; and also for apparently healthy children. The best example of 

 the outdoor school for normal children has been opened at Bryn Mawr 

 College, Pennsylvania, as the Phebe Anna Thorne Model School. 



' Henry Barton Jacobs, M. D., Journal of the Outdoor Life, April, 1908. 



J. H. Lowman, M. D., Trans. Nat. Ass. for the Study and Prevention of 

 Tuberculosis, 1907. 



The three Elizabeth McCormick Schools, in Chicago, are admirable ex- 

 amples of the open air school. 



