A few weeks ago, I encountered, a young child and his adult walking towards me on the sidewalk. As we drew nearer, the little boy – unprompted – pulled the loops of his face mask up over his ears, covering his nose and mouth completely. Then he waved happily, and we kept walking. This is everyday life during the 2020 pandemic. I couldn’t get my own kids to even wear mittens, but somehow this little guy knows that he needs to wear his face mask. It’s a temporary measure (we hope), but it makes one wonder about hygiene and public health and how things have changed over the years.
Before we knew about germs – bacteria and viruses – it was believed that illness was caused by ‘bad air.’ The 1853 school report for Exeter mentions air quality. “The time when any building was thought good enough for a school-house, that was capable of defending its inmates from the inclemencies of the weather, (and in many that was not thought to be a requisite,) has passed away, and a new age commenced. Now, school-buildings must be constructed on certain fixed principles; each scholar must have so many cubic inches of air, an opening in the roof to let the bad air out, (while the old ones had many holes to let the pure in)” In the following decades – really until the 20th century – the only focus on health was air. In 1860: “It shall be the duty of all the instructors to give vigilant attention to the ventilation and temperature of their school rooms. A regular system of ventilation shall be practiced, as well in winter as in summer, by which the air in the rooms shall be effectually changed at each recess, and at the end of each school session before the house shall be closed.” Teachers would throw the doors and windows open as soon as the kids cleared out. Class days were broken into two sessions of three hours each with an hour at lunchtime when everyone went home. For airborne diseases, this probably helped. But a lot of childhood illnesses passed via a different route.
Outhouses were standard before 1900. Sure, the fancy Robinson Female Seminary had plumbing and the Tuck High School, erected in 1913, could boast of its “excellent system of plumbing,” but most of the small elementary and grammar schools sprinkled around town were still using outside facilities. And outhouses, like porta-potties, had no provision for washing hands. We take it for granted today that a restroom will contain toilets, sinks, soap and hand drying. Back in the 19th century, if your hands didn’t look dirty, nobody thought anything of it. Now, in the time of Covid, we scrub up as though we’re about to perform open heart surgery. Even the little boy I passed on the street knows he needs to count to 20 before reaching for a towel.
Thirsty students had only one way of getting a drink – the shared bucket of water in the entry of the school. The 1867 school report found these to be lacking. “in one or two instances there was an apparent lack of a clean water-pail and dipper, and good brooms. None of these items are very expensive and we trust the Prudential Committees are or will be authorized to supply them where the want is acknowledged.” The shared dipper was one of the primary ways children shared disease. The Bill of Mortality for that same year listed 6 case of consumption along with dysentery, typhoid fever, polio and several cases of smallpox. In a town of 3500 people, there were 41 deaths total, 8 of which were children under the age of 10. Far more were made debilitatingly ill for very long stretches of time. It wasn’t until 1916, that Edward Green, the chairman of the school board, was able to announce, “All the buildings now have running water and are provided with bubbler fountains.” People today are more apt to carry a personal water bottle than use a public water fountain, but in their day the humble bubbler was considered the sanitary solution to fecal-oral transmission of disease.
As the 19th century closed, the idea that germs might be carrying illness began to take hold. There were still few ways to treat disease once it began to spread. The 1898 report mentioned a measles outbreak, “it is with feelings of gratitude that we are able to report that not one of our scholars died of this disease.” It was common for teachers to lose a few students each year. Measles, diphtheria, whooping cough, croup, or scarlet fever could shut down a classroom once it arrived. The simple installation of bathrooms and water fountains cut down on these illnesses tremendously. But before there were adequate vaccinations, mitigating the danger was the only defense. Tuberculosis was the biggest killer of the overall population. After Robert Koch was able to isolate the tubercle bacillus in 1882, there was a slow recognition that some of our most common habits (like spitting) might be causing all the havoc. Covering one’s mouth when coughing, using a handkerchief (and later, disposable tissues) to blow the nose became sanitary solutions in the fight against TB. Many men shaved off their beards – lest germs were living a party life in the whiskers (take heart, those of you who have grown out a ‘coronabeard’ – studies of modern hygiene practices have laid waste to the theory that facial hair harbors dangerous germs! Just shake out all the Dorito crumbs and wash your face).
The sanitary movement that swept the world in the late 19th century arrived just ahead of modern vaccination and antibiotic treatment. School board chairman, John D. Lyman, although still convinced that it was the air that caused the problem, understood by 1899 that public works projects improved public health. “Foul streets befoul the air and impure air produces ill health and causes death. Children thus weakened are more liable to die when attacked by active diseases. We want to keep the children in the best possible health.” His successors would embrace the germ theory and the public health measures that controlled disease. In 1901, the State of New Hampshire mandated smallpox vaccination for children attending public schools. Over the next twenty years, all the town schools were fitted with electric lighting, central heating and indoor plumbing. Beginning in 1916, school children were annually given a medical exam. Dozens of kids were discovered to have hearing and visual impairments, malnutrition, dental issues, hypertrophied tonsils, anemia and head lice. To remedy these problems, health and hygiene classes were made mandatory, schools hired medical staff, hot lunches were made available. As time goes by, these lessons evolve. Today, with plentiful but less healthy foods available, there are fewer underweight children. My kids taught me to cough into my elbow instead of my hands (good on you, kids!). This year, we’ve had to stop doing ordinary things that we never thought about – like hugging and shaking hands. Perhaps these will return once the pandemic is over. We’ll have to wait to see what we’re willing to risk. For now, let’s be careful. You might get a happy wave from a small child.
Image: The 3rd graders at Winter Street School were not required to wear shoes. A scarlet fever outbreak, six years earlier, was barely contained by the “prompt action on the part of the teacher in reporting her suspicions.” The health department ordered a quarantine of the family that likely saved lives.