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OKLAHOMA.

CLOUDMAN, H. H. Medical inspection in the public schools. Oklahoma school herald, 19: 14–16, May 1911.

The department of medical inspection was organized about October 18, 1910.

About 8,000 pupils were inspected. They were presented with cards which they filled out. They gave their personal history relative to contagious diseases and other ailments; and stated if they had had any trouble with eyes, ears, nose, throat or teeth, and if these had been treated.

Tbe findings were about the same as those of other cities. Fifty per cent or more had defective teeth; a per cent had some type of throat trouble, mostly enlarged tonsils; 9 per cent had eye trouble; and 3 per cent had ear troubles.

The board of health reports "all cases quarantined for any contagious disease and this in turn is reported to the principal of the school to which the child belongs and instructions given to exclude all others from this same family unless they have a certificate ... that there is no danger of further spread through them as disease carriers. The principals in turn report all cases of which they learn and these cases are reported to the board of health.”

PENNSYLVANIA.

DIXON, Samuel G. Medical inspection of school children. Pennsylvania medical journal, 15: 939 41, September 1912.

Also in Pennsylvania school journal, 61: 216-18, November 1912.

State law for medical inspection of school children in Pennsylvania passed in 1911; responsibility placed upon the school authorities with the exception of the districts of the fourth class which were sllotted to the State department of health providing the school directors see fit not to vote against it each year. ...

"The result of the influence of the efforts of the National league for medical freedom was as follows:

“The directors decided that 139 districts should not have examinations, which defrauded 214,000 children of help. In the fourth class 1,617 districts, representing 408,000 pupils, were also defrauded by the sets of the school directors. Therefore 622,000 children were left to go without the medical care given in other counties. This, however, left 652,000 who did reap the benefit of medical examination and of these, 207,000 were examined by the State department of health.

"As the result of this inspection, approximately 105,000 children were found to have one or more of the defects enumerated, 255,000 defects having been found by the inspectors. The returns from the teacbers at the end of the school year would indicate that thousands of our children have been directly

benefited by the inspection made last year.” HAMILTON, S., jr. Medical inspection of schools. Hahnemannian monthly, 47:110-17, February 1912.

"Medical inspection in Pittsburgh has in view two objects:

"1. Routine class room inspection, which is solely for the detection of communicable diseases, and which relates, primarily, to the immediate protection of the community.

62. The physical examination of each child, which aims to discover defects, diseases and physical condition, thus looking to the securing and maintaining of the health and vitality of the individual.

Physical examinations, to be effective, must follow the child from grade to grade and from year to year." Harrisburg. Department of medical inspection. Report. In Annual report

of the public schools, for the year ending June 1910. p. 51–53. Total purnber routine examinations..

7,504 Total number showing some defect..

2, 423 Defective vision... Defective bearing.. Defective teeth.

187 Hypertrophied tonsils.

805 Adenoids... Johnstown. (Board of school directors) Instructions to school physicians relative

to medical examination of school children in Johnstown, Pa. In its Report and manual, 1912. p. 27–31.

Each inspector must "make frequent examination of the general conditions of the buildings, noting cleanliness, toilets, heating, ventilating, lighting, condition of blackboards, and all things that may affect tbe general health of the school inmates. ...

"Each school physician shall also from time to time make such examination of teachers and janitors as the bealth of the pupils may require."

677 143

432

KEEN, Edwin L. Medical inspection and precaution in the schools. Pennsylvania school journal, 60: 407-408, March 1912.

Reprinted in Pennsylvania educational association. Directors' department. Proceedings, 1912. p. 121-22.

“The Harrisburg school district, on the advice of our superintendent, created a voluntary department of medical inspection, with one physician and one nurse, without cost to the district, in the year 1907-8. After one year's work the results were so gratifying that the district decided to continue the department the next year by the employment, on a fixed salary, of one physician and one nurse. The following year, an additional nurse was employed. ... A complete card system was instituted ... and a full set of blanks was provided... The following will show some of the most important defects: ... Malnutrition, 2.83 per cent; chorea, 0.162; heart disease, 0.473; pulmonary disease, 0.286; skin disease, 5.06; defective spine, 0.261; defective vision, 14.83; defective nasal breathing, 5.27; defective bearing, 1.38; defective teeth, 2.18; hypertrophied tonsils, 12.80; adenoids, 3.11. ...

Out of 1,416 pupils reexamined at the end of the first year, 448, or 31 per cent, had consulted the family physician." LAFFER, Cornelius C. The results of the examination of the school children of

Meadville and its importance. Pennsylvania medical journal, 15:941-44, September 1912.

Some 75 per cent of the children have bad teeth; from 15 to 20 per cent, enlarged tonsils or adenoids; about 10 per cent have defective vision. Philadelphia. Board of public education. [Health rules for infectious and con

tagious diseases in the public schools] In its Annual report, year ending December 31, 1910. p. 313.

“SEC. 2. It shall be the duty of the principals to report quarterly, to the superintendent of schools, the number of nonvaccinated children applying for admittance to their respective schools.

“SEC. 3. When smallpox, scarlet fever, diphtheria, diphtheritic croup, membranous croup, cerebrospinal meningitis, cholera, yellow fever, bubonic plague, glanders or anthrax shall exist in the family of any pupil or teacher, or any person connected with, any of the public schools of this district, or in the house in which any of said pupils, teachers or other persons reside, all such pupils, teachers or other persons shall be excluded from school and the school building, and shall not be permitted to return until he, she, or they shall present the written approval of the bureau of health.

“Sec. 4. When measles, german measles, chickenpox, mumps, or whooping cough shall exist in the family of any pupil or teacher, or of any person connected with, any of the public schools of this district, or in the house in which any of said pupils, teachers, or other persons reside, no such pupil, teacher or other person shall be permitted to attend school or enter the school building, without the written approval of the bureau of health; such approval to be based upon careful examination of all the circumstances surrounding the case.

“SEC. 5. Any pupil suffering from tonsilitis, contagious eye diseases, or parasitic diseases of the head or body, must be excluded from school until the bureau of health shall have certified that all liability

to communicate the disease to others has passed." Reading. Board of education. Medical inspection. In its Annual report, 1910–1911. p. 10–12.

“The sanitation committee of the school board has conducted experimental medical inspection for several years. ... Of 8,331 pupils examined, up to June, 1910, 4,372 suffered with defects." Defective vision.

1,526 Defective hearing. Enlarged tonsils...

1,954 Adenoids...

About 6,108 separate defects were found.

The school nurse assists in the medical inspection. In addition to medical inspection by a physician, pupils suffering from stuttering are treated.

In 1910 the Reading dental society detailed 25 of its members to inspect the teeth of the pubilc school pupils. Of 8,925 examined, less than 3 per cent had perfect teeth, of nearly 9,000 examined in the winter of 1909-10, only 4,849 had ever used a tooth brush, 1,369 had ever been to a dentist, and 1,094 had had permanent teeth extracted. Permanent teeth cavities.

28, 548 Temporary teeth cavities.

14,707 Green stain.

5, 910 Abnormal gums. Tartar...

1, 866 Abnormal occlusion..

733

351

925

1,554 Atrophy of teeth. Mouth breathing. Putrescent pulps.

1.894 Exposed pulps....

1,717 A free dental clinic was organized and in eighteen months treated the teeth of 275 pupus.

308 236

RHODE ISLAND.

CHAPIN, Charles V. Medical inspection of schools in Providence. [Ansonia, Conn., The Emerson publishing co., 1909) 15 p. 8°.

Begun, in Providence, R. I., 1894, following Dr. Durgin's work in Boston; teachers and parents of pupils in large grammar school subscribed a sum of money and hired a physician as school physician for one month. Appropriation of $1,000 for school inspection followed the results obtained-two inspectors, a man and a woman were appointed.

In Providence, the children come to the inspector. On every school day in the year an inspector is on duty at the city hall, between 12 and 1 o'clock; he examines the children sent by the teachers; to them he gives a note stating his findings, which the children take to their teachers. Teachers are "expected to see that the child's parents are notified, and if any treatment is necessary to see that it is

carried out.” Providence. School committee. [Medical inspection] In its Report, 1909–1910. p. 126–28.

Signed: Elen Le Garde.

"In the spring of 1904, medical inspection was inaugurated in the Providence schools. Since March 1, 1909, three inspectors have been employed, and on April 1, of the same year, this inspection was extended to the parochial schools. ... In 1906 a school oculist was employed. ... The great part of the work of the school inspectors is with contagious skin diseases and pediculosis. These cases are treated at the city hall and the material needed furnished by the board of health.

Lo February, of 1909, a school nurse was introduced. She follows up the cases from the school to the home; . . . also sees that children sent to the oculist and to the hospital get there. School baths have been in existence since 1905. . . . Four school matrons attend to the daily baths in the different buildings."

SOUTH CAROLINA.

GANTT, L. Rosa H. Medical inspection of schools in Spartanburg, S. C. South Carolina medical association, Journal, 7: 329–34, September 1911. tables.

Reprinted in Pediatrics, 23: 337–42, June 1911.

Following the work of Dr. Hines in Seneca, S. C., the Spartanburg County, S. C., Medical society undertook the examination of Spartanburg city school children, 1910–11, without charge.

Scope of work: (1) The detection of parasitic, infectious and contagious diseases; (2) exclusion from school of all children affected with acute contagious diseases; (3) inspection of each school child for physical defects and noncontagious infection; (4) inspection of the hygienic and sanitary condition of the school buildings and premises.

In each case, the inspectors made complete record on three blanks: (1) A history card kept by the Elaminers; (2) a record card kept by the school authorities; (3) a notification card sent to the parent.

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32 24

19

HINES, E. A. A plea for medical inspection of school children in South Carolina

Report of the work at Seneca. South Carolina medical association. Journal, 6: 454–57, September 1910.

“The Seneca schools are the first in South Carolina to put in operation the modern idea of medical inspection," beginning September 23, 1909. Staff of examiners: Two competent dentists, an eye and ear, nose and throat specialist, two general practitioners, and a secretary; 200 children, ages 6 to 18, pupils first to tenth grades, examined. Children having

Number
Defective teeth

(Number of teeth, 600.)
Defective tonsils.
Enlarged glands.
Adenoids...

3
(Number of suspects.)
Eye defects..
Nasal defects.

3
Skin lesions..
Orthopedic defects.
Teeth brushed daily.

170 "I can not find any report on the negro school child in the South. I examined a representative number and found in general faulty nutrition, practically all with teeth defects --contrary to the idea that prevails. Fewer serious tonsil defects compared to the whites, more skin lesions. I did not examine for adenoids. A fair proportion had used the tooth brush.

"I also examined a representative number of cotton-mill children among the whites. Ninety per cent had bad teeth-not one used a toothbrush." South Carolina. State board of health. Hookworm disease. In its Thirty-first annual report, 1910. p. 15–18. table.

From October 1 to December 10, 1910, in five counties, 4,695 children were examined clinically; 80, microscopically; 165 cases treated; 47 per cent gave clinical evidence of being infected with the hook.

2

worm,

South Carolina. State board of health. Medical inspection of schools. Its Monthly bulletin, 1: 3–29, October 1910. tables.

“The Southern States have been behind almost all the rest of the countries of the civilized world in introducing medical inspection of schools. ...

“New Orleans was the first Southern city to take active steps in this direction in 1908, and Atlanta, in 1908 and 1909. In South Carolina the complete modern idea of medical inspection of schools was inaugurated in the Seneca graded and high schools, September 23, 1909. ... The examination (was) conducted by two general practitioners of medicine and surgery, two dental surgeons and one eye and ear, nose and throat specialist, a secretary and the teacher of each grade."

19

of the defects discovered among 200 pupils, "children of the very best and most prosperous citizens of the Piedmont section,” were: Glands enlarged..

24 Eye defects. Teeth defects.

153 Tonsil defects.

32 Not vaccinated.

168 "A representative number of children of the cotton mill and negro schools disclosed a much greater number of defects." (South Carolina] The veto of the Medical inspection bill. South Carolina medical association. Journal, 8: 62–63, March 1912.

Passed, with some amendments by the General Assembly, and vetoed by the governor. WARD, J. La Bruce. Hookworm disease; its eradication in South Carolina. South Carolina medical association. Journal, 7: 341-43, September 1911.

Work in the schools of 11 counties in South Carolina, chiefly the southern and southeastern parts; of the 1,100 children examined, 374 per cent were infected.

"That is, they gave clinical evidence of the disease. A microscopical examination would show a much heavier infection. Following that we examined about 4,500 children in Kershaw, York, and Abbeville. The lightest infection was in Abbeville County. We believe the adjoining counties will have as light an infection. Dr. Weinbery examined 1,180 children, and found only 7 suspects; whereas“ in some other parts of the State we found at least 75 per cent of the children showing clinical evidence; ... and I am satisfied, from the microscopical findings so far ... would have shown an infection of 100 per cent. ... At Furman university, where 100 specimens were examined, without examining the men at all until after ... 38 per cent were found infected; ..

... and I should not have made a single diagnosis on clinical findings.

"At Clemson College we found 33 per cent of 85 men examined infected, and I would not have made a clinical diagnosis of any of those cases.

*Taking the 9,000 children examined in the State, we find an infection of over 25 per cent, clinically; ... microscopical findings would have run much higher.”

TENNESSEE. HILL, David Spence. The status of school hygiene in Tennessee. In American

school hygiene association. Proceedings, 1911. Springfield (Mass.] 1911. p. 155-63.

There is little teaching of school hygiene in its technical aspects in Tennessee. The State has no general law requiring medical inspection of school children. In Knoxville, Memphis, Chattanooga, and Nashville encouraging beginnings have been made, but “no full-fledged system with sufficient nurses, trained physicians and thorough organization supported by the city or State exists in Tennessee.” During 1909–10 examination of throat and teeth was undertaken in Nashville. The following summary was presented by the inspector, Dr. E. L. Roberts, on December 26, 1910: Popis examined..

2, 455 Detective vision.

148 Crossed eyes.. Tracboms.. Other eye inflammations Discharge from ear. Frequent earache... Enlarged tonsis. Defective teeth.........

36 117 68 24 123 199 698

TEXAS.

Fort Worth. (Superintendent of schools Report of the medical supervisor. In his Annual report, September 1910. p. 35-47.

"Physical examination of school children was begun April 1. ... In all, over 1,000 children were examined, of these 710 were referred for treatment-medical, surgical, or dental. (It was not possible to examine systematically each child so near end of school year.)"

The first to fourth grades inclusive in all schools were inspected, and in most of the districts all grades.
The 710 cases referred may be summarized as follows:
Eses.

209 Tonsils

300 Adenoids. Ears. Enlarged glands of the neck. Apardis. Tuberculosis

132

77 123 72 12

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