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First Open Air School in St. Louis

Children taking graduated exercise at open-air school, St. Louis, Mo.
Children taking graduated exercise at open-air school, St. Louis, Mo.
Cots used in open-air school, St. Louis, MO.
Cots used in open-air school, St. Louis, MO.
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Children taking graduated exercise at open-air school, St. Louis, Mo.Tuberculosis was rampant among poor families in congested cities, including St. Louis, in the early 1900’s.  If one family member became contagious, the rest of the household frequently developed active infections. Undernourished children living in crowded, unsanitary homes with tubercular relatives were particularly vulnerable. Although Robert Koch had discovered the bacterium that causes tuberculosis in 1882, effective antibiotic treatments were not available until the middle of the 20th century. Therefore preventative efforts were essential to reduce mortality.

It was believed that a high degree of exposure to fresh air could stem the progress of the disease and possibly provide an actual cure for early-stage cases; this belief motivated the establishment of open-air schools for infected children. The first of several such schools in St. Louis opened in August of 1911, and observations of its success were published in the United States Public Health Service Bulletin No. 58 (October, 1912), held in the Bernard Becker Medical Library in its original printed format.

The bulletin’s author, Dr. Benjamin S. Warren, was the medical director for the St. Louis Society for the Relief and Prevention of Tuberculosis. The Society sponsored a specialized public school for children identified as at risk for developing tuberculosis, which soon served 25 children with another 71 on the waiting list. The school required a strong collaboration between the city’s school board, which supplied the specially-designed facility, teacher and related academic equipment, and the charitable Society, which supplied appropriate food and clothing. Dr. Warren suggested that ideally the city’s board of health should furnish the nurse, cook, and night watchman.

Dr. Warren published his observations of the school’s success in the United States Public Health Service Bulletin No. 58 (October, 1912). The report recognizes that totally removing children from their family homes was undesirable, but sending them to an accessible day school in a natural and hygienic environment, preferably in a wooded suburb, offered many healthful benefits.

“The principles of the open-air school are those of personal hygiene, fresh air, cleanliness, proper clothing, proper diet, rest, and recreation.” (p.4). Getting inner-city children into a healthy environment was the goal; meeting their myriad basic needs became the answer. Upon arrival, the children took showers, dressed in clean clothing and dry shoes provided by the school, and had a nutritionally adequate meal before beginning their day’s studies. The teacher was encouraged to include exercises, folk dances (preferably accompanied with a piano) and play within lessons. The morning’s school work was formally interrupted for recess, and after a hot and wholesome midday dinner everyone rested for an hour before resuming their efforts. Another light meal was served before the children changed back into their personal clothing and were dismissed for their homes.

The benefits of good hygiene, sufficient nutrition, appropriate clothing, enjoyable activity and a nap extended to the teacher as well as her students: “The teacher will soon find that following the outdoor life has made her feel brighter and more efficient and not subject to the flag attendant upon indoor teaching. If she will rest with the children during the rest hour, she will do even better work.” (p. 10).

Cots used in open-air school, St. Louis, MO.

Given such a nurturing atmosphere, it is not surprising that the children enjoyed coming six days a week, and unanimously voted to continue coming even during the Christmas holidays. (p. 12). Dr. Warren noted that “[t]he percentage of absentees is much less than in the public schools.” (p. 13).

This enlightened, holistic approach to the physical well-being of each child had the desired effect. Formerly sickly children made significant weight gains and their improved health helped them to resist falling victim to the tuberculosis bacterium present in their homes. Their academic progress also surged ahead: “[t]he progress in their grades is remarkable, even though they work little more than half the time. As compared with the children of the public school, they not only keep up in the grades but many (nearly 50 percent) go ahead. The St. Louis open-air class completed in 8 months’ time the usual amount of work done in the public school and 20 percent more.” (p. 13). Dr. Warren found it impossible to determine exactly which features of the overall program contribute the most to academic achievement, but recognized that having an exceptional teacher for a relatively small class must be one important factor.

He then proposed that the same notions should be applied to all public schools, since the returns are so definite. “Now that the benefits to the subnormal child are so thoroughly proven and accepted, why not apply the same principle to the normal child? Why not give it the same advantages? The results would probably be just as satisfactory.” (p. 14). Although the open-air school movement believed that fresh air was the primary restorative element, providing a nutritious diet, warm dry clothing and a regular balance of work, play and rest were all crucial to the health and productivity of these children.

The point is no less relevant today than it was a century ago. In typical public elementary schools, overburdened teachers try to keep restless children focused on academic tasks without enough time for physical exercise, imaginatively exploring the arts, or the brief freedom of recess. One wonders how much better modern children would learn, and enjoy the process of learning, if they and their teachers all had three complete meal breaks, occasional periods of dancing, and a refreshing rest hour each day.



Warren, Benjamin S. "Open Air Schools for the Prevention and Cure of Tuberculosis Among Children." Treasury Department, United States Health Service. Public Health Bulletin No. 58, October, 1912.

United States. Bureau of Education. Report of the Commissioner of Education for the year ended June 30, 1912, Volume 1. Washington: Government Printing Office, 1912. (View at Google Books.)

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