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203 15 33 31

8 10 25

Teeth....
Speech..
Nervous disorders.
Acute throat trouble.
Mentality..
Kidney and urinary.
Miscellaneous (about).

“ The water tanks now in use are never sterilized, or even cleaned with brush and water. The drinking cup problem is unsolved.” Houston. [School board] Report of medical inspector, June 15, 1911. In its Annual report, 1910-1911.

Signed: W. Wallaco Ralston, M. D.
Thirty-eight children, with trachoma, excluded; 74 with symptoms of trachoma.
Houston dental society gave lectures to the children on “The care of the mouth and teeth."

Free eye, ear, nose, and throat clinic established in connection with the city health office, and free dental service offered by the Texas dental college for poor children. STILES, Charles W. Special report on a preliminary survey of Texas to deter

mine the distribution of hookworm disease. 13 p. table. mimeographed.

p. 59-60.

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Geographical distribution by counties, p. 5-9 (found in at least 45 counties. Most of the infection thus far known was in the eastern part of the State).

School children: p. 9–13. table.

"Of a total of 1,776 school children seen in 11 different schools and orphanages, 21.5 per cent showed symptoms upon a quick inspection which justified the suspicion that they had hookworm disease. Of 876 boys, 30.7 per cent, and of 900 girls, 12.6, came into the suspect category.

“Of these 1,776 children ... about 46 per cent ... were clearly below par, physically. ... This does not mean that 46 per cent were classified as hookworm suspects. These figures show that nearly half were below normal and that in that condition they can not possibly digest all of the education offered them.

“In some regions about 30 per cent of the school children harbor the disease.
“A campaign against the disease ought to be undertaken without unnecessary delay.
“The public schools of Texas are badly in need of a medical inspection system. . .

“The sanitation of the school yards is in sad need of attention; their present condition makes them centers from which the various soil-pollution diseases may be spread. In several school yards examined as to sanitation the grading was only 10 on a scale of 100. According to information obtained from one county superintendent of education the index (healthsul condition) of 90 per cent of the rural schools in his county is zero (0) on a scale of 100."

VIRGINIA. PLECKER, W. A. The economic phase of hookworm disease. Virginia medical semi-monthly, 16: 213-15, August 11, 1911.

"In the four counties of Southside Virginia . . . I find an extremely serious phase of the subject. ... The rural schools in which these examinations have been made show about 50 per cent of infoctions. ... In one badly infected portion of my territory there live 20 families with 35 or 40 children of school age. This whole community supplies just two pupils, little girls, to the nearby school. In not one of thesa families is there the slightest semblance of toilet arrangements. ... Not one-fourth of these adults possess even the rudiments of an education."

“FOOTNOTE.-In reports from seven teachers of Richmond County, statement is made that from 20 to 60 per cent of their labor is lost on account of the presence of hookworm disease, the average of all being

40 per cent." Richmond. Superintendent of public schools. Medical and dental inspection. In his Annual report, year ending June 30, 1911,

South Richmond physicians, session 1910-11, conducted examination of 1,380 pupils. Results: Defective eyes, 380 cases; enlarged tonsils, 237; adenoids, 111; defective hearing, 13.

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Examination of mouth conditions made by the Dental association of Richmond, elementary school pupils. Total examined, 10,919. Pupils having perfect teeth, 1,125; total number of cavities, 20,084.

The city council, by appropriation in March 1911, provided for two physicians and five nurses, including the nurse already at the John Marshall high school; appropriation available, Soptember 15, 1911. Virginia. (State) Commissioner of health. Hookworm disease. In his Annual report, year ending September 30, 1911. p. 19–31. tables.

In Mecklenburg County, of 279 rural school children "taken at random, 133, or 47.7 per cent had hookworm."

WASHINGTON.

p. 37-39.

Spokane. (Board of education Medical inspection. In ils Biennial report; for the two years ending June 30, 1910.

Department of medical inspection organized at opening of school year 1909-10; chief inspector and lour assistants. Regular inspection began September 1909. All schools shall be inspected at least once a week (conditioned). Monthly report to be made by the chief medical inspector, of all work done, copy given board of health, and board of eduaction. Each school principal to make weekly report to superintendent of schools.

Summary of chief medical inspector's monthly reports. Total individual inspections of pupils, 84,232. "In addition to the work ... designed for protection of the schools and communities against conIngion and infection, there was a thorough inspection of all the school children for defective vision and other eye troubles, for enlarged tonsils, adenoid growths, defective teeth, and other forms of physical

Infirmity." THOMPSON, N. L. Medical inspection of schools. Northwest medicine, n. 8. 3: 134-37, May 1911.

Bibliography: p. 137. "Keplies received from nine cities showing that medical inspection to a greater or less cxtent was utilized in Seattle, Spokane, Tacoma, Everett, North Yakima, Olympia, and Aberdeon; negative replies were received from Walla Walla and Wenatchee, and no reply from Vancouver and Belling

bism. , ..

“Educational agencies must employ expert medical inspectors who shall seo that the health of the school child is conserved.

"It ought not to be an incidental activity of some department but must eventually outrank all others in power as it does in importance. It should aim to accomplish the following: (1) Frevention of infectious and contagious diseases. (2) Scientific supervision of sanitary condition of premises, school build. ines, furniture, etc. (3) Teaching of hygiene to teachers and children and through them to the community. (4) Physical education, including supervision of manual training, gymnastic exercises, organind games, etc. (5) Physiology and psychology of ordinary educational methods, including fatigue, euratbenia, hysteria, questions of sex, etc. (6) Special educational methods for abnormal chilrdenthe mentally and physically defective, the dull and backward, the blind, the deaf, etc. ...

"The medical inspector must, therefore, be broad minded, with sound and extensive medical knowledge, interested in child life, sympathetic, tactful, an investigator; in short, a medical man, a psychologist and a pedagogue."

WISCONSIN.

BARTH, G. P. Medical inspection of schools in Milwaukee. Wisconsin medical journal, 9:151-62, August 1910.

Begun Fall of 1907. The city is divided into nine geographical districts; eight, approximately equal in size and contain shout the same number of schools; the ninth in the central, or slum district, covers less area because conditions are worse. Each district is under the care of one Assistant medical inspector. For the work of the nurses, the city is divided into four districts, the three outlying territories about equal in size, the central one, smaller.

“Backward" cases are reported by teacher to the chief medical inspector, on the psychological examiration blank, on which she records all the family and school history of the child she can collect. When foued below par, mentally, by the chief medical inspector, the child is transferred to the "exceptional” school. Classes for the stammerers have been opened; three classes for the blind, in the public schools; the deal and dumb segregated into a school. No provision has been made for the weak, the anemic, or the crippled.

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JONES, Richard W. Medical inspection of schools. Wisconsin medical journal, 10:319–27, October 1911.

Inaugurated in Wausau, Wis., following scarletina epidemic 1909–10. First intention simply to ex. amine for contagious diseases, but work was extended to cover physical examinations.

During the year, up to May 1, 6,677 children were examined for contagious diseases, and about 1,600 given physical examinations. Among defects found were: Scabies, 33; impetigo contagiosa, 35; enlarged tonsils, 744; adenoids, 170; defective vision, 43.

The effect of medical inspection has been to increase the average daily attendance in the schools. With practically the same total enrollment this year (to date April 1, 1911] that there was last year, there have been 8,2774 days more attendance than for the corresponding months of last year ... at no additional expense for instruction.

“The fallacy of our system has been that we have not had enough authority to enforce our rulings. Many parents refuse to have their children examined or to follow the instructions of the examiners. ... We should have legislation to cover this point. .

... We should have compulsory examinations of the school children, at least for contagious diseases and eye and ear diseases with possibly diseases of the nervous system. ... This law should provide for the control locally of the examining bodies, and ... examining physicians should be trained along these special lines.”

Discussion: p. 327-35. In Milwaukee: p. 327-29 (Barth, George P.). In Madison: p. 329 31 (Bardeen, C. R.).

MADISON.

Madison. Superintendent of public schools. Medical inspection in Madison.
In his Annual report, 1910–1911. p. 44–51. chart. p. 47.

Made under direction of the Madison antituberculosis association, W. D. Frost, president; assistant nurse, Miss L. Dietrichson; 6 of the 11 city schools, pupils axamined and eyes tested. There were examined 1,152 children; but 422 had been vaccinated.

ME

99

Cases.

Cases. Defective vision 340 Defective teeth

604 Disease of the eye. 41 Skin disease

17 Defective hearing

Cough.

118 Ear disease. 96 Throat trouble

281 Defective breathing. 246 Lung trouble

56 Adenoids, known cases

20
Anemic..

108 Milwaukee. Board of school directors. The dental clinic [and medical inspection] In its Annual report, year ending June 30, 1911. p. 82-94. tables. diagrs.

The Free dental clinic established in the quarters of the department of medical inspection, under charge of the Milwaukee public school free dental clinic association; members of the clinic pledged to serve one-half day each month; all the expenses except the rent of room, borne by the association. Work began February 20, 1911: Number of treatments given, 349; number of permanent teeth filled, 584; number of permanent teeth extracted, 41.

“It is sometimes desirable that a medical examination be had in certain cases in order to determine (a) the advisability of school attendance, (6) the necessity for temporary absence from school, (e) the limitation of the amount of school work to be done, (d) attendance at special schools or classes, (e) medical or surgical procedures necessary or advisable to promote good health or to promote school progress by the removal of physical disabilities, and the department of medical inspection has been freely consulted by other departments in these matters. The following cases were submitted: (1) the truancy department referred 51 cases for nonattendance. (2) By the superintendent's department, 5. (3) by teachers and principals, 42. (4) By the State factory inspector for advice as to the kind of employment per missible to the child, 2. (5) By parents, 19. (6) By doctors and nurses, 129.

On October 24, 1910, The common council passed the ordinance, the text of which is as follows: "An Ordinance to protect the health of school children. ...

Sec. 1. No parent or other person having charge or control of any child between the ages of seven (7) and sixteen (16) years shall permit or allow such child to attend school in a filthy or neglected state, or affected with pediculosis, ringworm of the body or scalp, scabies, impetigo contagiosa, molluscum contagiosa, or infectious dermatitis, or any other contagious or infectious diseases; and any parent or other person having charge or control of any such child so affected shall, alter receiving notice given under authority of the board of school directors that such child is so affected, remedy such condition within the following time: Ringworm of the body ( Tinea circinata)..

..days.. 30 Im petigo contagiosa.

do.... 30 Molluscum contagiosa..

..do. Infectious dermatitis.

.do.. 30 Pediculosis of any part of the body.

do. Ringworm of the scalp ( Tinea tonsurans).

months.. 3 Favus....

year.. Scabies of any part of the body

days.. 14 And any other contagious or infectious diseases within a reasonable time

21

14

1

"SEC. 2. Any person violating any of the provisions of this ordinance shall be punished by a fine of Dot less than $1, nor more than $50 for each and every offense, and in default of payment thereof shall be confined in the house of correction of Milwaukee County for not less than ten days or more than sixty days.

"SEC. 3. This ordinance shall take effect and be in force from and after its passage and publication." See also p. 28–36 (Elementary grades).

Number withdrawn from school on account of personal illness, 56; mental inability, 13. Failure of promotion because of personal illness, 335; physical defects, 169; inability, 1,900. TOBEY, Silas B. A successful plan for medical inspection. American school board journal, 42: 9, May 1911.

Established, September 1910. Seven physicians are employed, one for each school center-eight schools, two of which are within half a block of each other. Each physician visits his school at 9 a. m. on each of the five school days of the week, receiving $1 for each visit. The parochial school children sre also sent to the examining physicians.

Every child who has been absent one-half day without prior knowledge and consent of teacher must obtain from physician of his school, a clean bill of health before he may resume school work. A free afirmary and two visiting nurses are supported by private subscription. Poor children are treated free and the nurses visit the homes.

"The etiect of medical inspection has been to increase the average daily attendance in the schools. With practically the same total enrollment this year that there was last year, there have been 8,2771 days more attendance than for the corresponding months of the year The same number of teachers ... able to care for an average of 83 more pupils in daily attendance this year than we had last year at no additional expense for instruction. .,. We have found the medical inspection one of the most valuable adjuncts to our schools."

MEDICAL INSPECTION RECORDS.

GENERAL REFERENCES. AYRES, Leonard P. Forms for record-keeping. In his Open-air schools. p. 139–48.

Open-air school records of the medical inspection and condition of the pupils: Chicago, Boston, Hartford, Providence. Cleveland. [Board of education) Card and record system. In its The work of

medical inspection with statistical report, Cleveland public schools 1910–1911. p. 21(20)-32.

Cleveland's use of system: p 37–46. CORNELL, Walter Stewart. Good and bad forms of record keeping. In Ameri

can school hygiene association. Proceedings, 1911. Springfield, Mass., American physical education review, 1911. p. 65–73.

"Every record card should provide accommodation for a number of examinations, at least four. ... It should provide for a record of the notification to parents .. together with the date of such notification and official information as to whether or not the defect has been corrected. The age, grade and social condition of the child should be noted and briefly commented upon ... in connection with the record of his physical defects. ... The principal defects ... are only ten in number and ... may well be given a definite mention upon the record card, since an inspector is less likely to overlook a defect in a child when he is compelled to make a definite record whether or not it exists. For this reason the eye, nose and throat, the ear, teeth and nutrition should be given permanent space on the card; and the skin, the skeleton, the glandular and nervous systems and the mentality should have

a definite mention." CORNELL, Walter Stewart. Keeping of records. In his Health and medical inspection of school children . . . 1912. p. 45–57.

University of Pennsylvania, physical record card, p. 49; Dr. Ne payer's card, p. 57.

Su olao p. 568-77. tables. MacMURCHY, Helen. (Facts to be noted in examination of feeble-minded chil

dren] In American school hygiene association. Proceedings, 1911. Springfield, Physical education review, 1911. p. 80.

1. Date and age. 2. Name, address, school, class, etc. 3. Condition of teeth. 4. Condition of nose. S. Condition of throat. 6. Condition of vision. 7. Condition of hearing. 8. Speech. 9. Reading. 10. Writing. 11. Number work. 12. Hand work. 13. Attention. 14. Memory. 15. Intelligence. 16. Aptitudes 17. Moral sense. 18. Physical condition. 19. Gout. 20. Coordination. 21. Cause of backwardness, 11 known.

Rochester (N. Y.) record cards. American school board journal, 45: 44-45, August 1912. figs.

"The health card is made out by the teacher and sufficient for the entire life of a pupil. Entries are made by the school nurse or the teacher from the examination of the medical inspector. On the reverse side space is provided for diagnoses of defective conditions and statements of treatments recommended."

VACCINATION.

KERR, John W. Vaccination. An analysis of the laws and regulations relating

thereto in force in the United States. . . Prepared by direction of the SurgeonGeneral. Washington, Government printing office, 1912. 82 p. 4°. ([U. S.)

Public health and marine-hospital service. Public health bulletin no. 52) St. Louis. Board of education. Report on vaccine virus and on the results of

vaccination in the public schools of St. Louis, 1912. In its Official report, 18: 564-68, February 13, 1912.

Regarding the vaccination of 577 children vaccinated by the vaccine physicians of the health department, and 218 vaccinated by physicians in private practice, in contrast to the excellent public vaccinations, it was found in several schools that the private operations by certain physicians were unitormly negative.

In the cases in private practice it was discovered that the proportion of takes for the year was "still dangerously low, leaving 63 unprotected persons per 100, instead of 22 per 100 among those vaccinated by the health department.”

The inspections for the last two years exhibit the great advantage of public vaccination. The reg. ular vaccination of public school children is the most important prophylactic work done in the city.

See also p. 417 (December 12, 1911). List of cities requiring evidence of successful vaccination as a condition of admission to the public schools: Baltimore, Boston, Buffalo, Chicago, Cincinnati, Cleveland, Detroit, Los Angeles, Newark, New Orleans, New York City, Philadelphia, Pittsburgh, San Francisco, and Washington.

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