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INSPECTION FOR COMMUNICABLE DISEASES.

GENERAL REFERENCES.

DIXON, Samuel G. The medical and sanitary inspections of schools and their

relation to the tuberculosis problem. In American school hygiene association. Proceedings of the first, second and third congresses. Published November, 1910. Springfield (Mass.) American physical education review, 1910. p. 35-42.

Read at the second congress, 1908.

“The decrease in mortality from tuberculosis has apparently been greatest in those States where systematic popular education for its restriction has been most active and general. There is no other known cause capable of producing such a gradually decreasing effect as is shown to have occurred. ... "Is there not reason to suppose the systematic education of our school children in the essential facts

would be followed by a still more noteworthy reduction in the next generation? Should it not be a part of the regular curriculum of every school in the country?FELL, A. S. The prevention of the spread of contagious diseases, particularly among children. American journal of public hygiene, 20: 82-91, February 1910.

“There should be a thorough system of medical inspection of all the school children in the city, State, public, private and parochial." International municipal congress and exposition. First. Contagion and

school inspection. Discussion. In Municipal advance. Extracts from papers read. Chicago, September 18–30, 1911. p. 117–19.

The conference as a whole voted in the affirmative on the following questions:

1. Should carriers be excluded from school? 2. Should vaccination be required for school children in cities, in small towns, in the country? 3. Should schools have physical examinations? 4. Should

schools have dental examinations? United States. Department of commerce and labor. Bureau of the cen

sus. [Mortality from children's diseases in Registration area, 1910: Ages 5 to 14] In its Bulletin, 109: 118.

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WILE, Ira S. The social plagues and the public schools. New York medical journal, 92: 501-504, September 10, 1910. tables.

Reprinted.
Also in American academy of medicine. Bulletin, 11: 496–505, October 1910.

“The school throws no mantle of protection, educationally or physically, about children, when they most require it.

“In 1900, there were 446,133 teachers in the United States, of whom 118,519 were males and 327,614 were females. If ... it is a “conservative estimate that in this country the morbidity from gonorrhoea would represent 60 per cent of the adult male population and that of syphilis from 10 to 15 per cent,' are these teachers a possible source of infection of public school children? Are the janitors, scrubwomen, school attendants a source of possible infection of the children? ...

“Venereal diseases among the colored children are said to be unusually common according to Southern physicians, and there are 872,344 negro children between the ages of 5 and 14 in the elementary schools. . . .

“The prevention of the social plagues is one of the intrinsic problems of our present school system."

Dr. Wile's statistics give some idea of the extent of the diseases among school children. He emphasizes existent evils and makes a plea for the fullest effectual work of the medical inspectors of school children, that the diseases when found be specifically called by name, and that preventive means be radically enforced. He says, further:

"Prophylaxis means increased attention to school hygiene. Drinking fountains must supplant the foul drinking cups. Individual towels are absolutely necessary. Pencils, sponges, books must be individualized; and the children must be impressively instructed not to lend them to each other and ... to avoid putting such articles in their mouths. Toilet facilities should be improved. The toilets of the two sexes must not be within earshot of each other. . . . Complete physical examinations Ebould be required. ...

"Manifestly, children who are a source of contagion to others must be excluded from school ... until they are no longer a menace to the health of their fellow school children.

"Boston, Philadelphia, Chicago exclude the children when the diseases are ... recognized by the medical inspectors. e..

"Medical inspection must progress so as to be of greater value. The classification of the defects of school children should be placed upon an aetiological basis." WILLSON, Robert N. The economic relations of social diseases. Pennsylvania medical journal, 15: 843–55, August 1912.

Has the public “a right to demand instruction regarding the many more than 100,000 infected sufbrers supposedly intermingling in the homes and lives in every city ... ?

"The richest and the poorest strata of society (are) the two most thoroughly saturated with these poisons. ...

** What do we hear of the blind asylums, 20 per cent of whose inmates are there because of gonococcus birth infection; ...of the insane asylums with 85 per cent and upward of the cases of paresis due to syphilis; and over in the nervous wards a very like percentage of cases of locomotor ataxia due to the sume disease? ... What of the children's wards in hospitals, never free from little children who are in lected; of the general wards ... full of the debilities .. the marasmus, the idiocies, the apoplexies, the epilepsies, the club feet, the hare lips, the maimed and crippled special senses. ...

“We are officially informed that in our army of about 60,000 men not less than 20 per cent of all upon the sick list are instances of venereal infection. . . . For the navy and marine corps ... for all venereal diseases the primary admission ratio was 199.17 per 1,000."

* In the Public health and marine hospital service ... about 1,300,000 (patients have been treated, in the last 20 years. Of these, 106,090 were cases of syphilis; . . . 4,420 constituting the average per year,.,. 117,336 cases of gonorrhea, with an annual average of 4,889 cases.

"No reference has been made to the new wave of venereal infection brought to this country each Fear from the continent. ... Last year 223,453 immigrants came from Italy alone, 123,348 from Poland, $1,000 Jews, 71,000 Germans, 52,000 Scandinavians, and many others; . . . not one of the entire number having been examined for the presence of venereal disease and all admitted through a wide-open pbysical gate."

IN REPRESENTATIVE CITIES.

BERKELEY,

CAL.

HOAG, Ernest Bryant and HALL, Ivan C. A preliminary report on contagious

diseases in schools. American academy of medicine. Bulletin, 13: 81-87, April 1912. charts.

Reprinted.

* The necessity for the correction or control of such physical defects as those of hearing, sight, circulatory disorders, obstruction of the nose and throat, as well as certain deformities, such as those of the spine, chest, feet and legs, might often be avoided, is proper attention to the contagious diseases of childhood were given serious consideration during school life.

** The principal points then to be considered in relation to contagious diseases in schools are:
**1. The direct effects of the diseases themselves.
**2. The direct or indirect effects of such diseases in producing physical 'defects.'
*3. The relation of these diseases to retardation and elimination.

*4. The cost to the school department through decrease of average daily attendance, on which appropriations are often in part based.

"5. The cost to the family for medical treatment, nurses, etc.

"6. The cost to the individual through general lowered vitality or direct physical disability of one sort or another.

“ In order to study with any degree of accuracy the effects of contagious diseases in schools, certain furate methods for keeping records must be devised and carefully followed. For the purpose of Lustration the following method is presented as having proved satisfactory in the schools of Berkeley.

"1. Every case of contagious disease is reported to the city health department and here recorded by the card index system.

"2. The health department notifies the school department in each case, and a similar record is made bere.

"3. The school department notifies every principal of a school in whose district a contagious disease is reported.

" 4. Every principal inquires carefully into the cause of continued absence on the part of the pupil, and notifies the school department of every contagious or suspicious disease which first comes to his attention.

"By this cross-checking method there remains very little chance for any contagious children's disease to fail of being reported and properly recorded.

“5. A contagious disease map is made of the entire city and arranged by school districts, thus indi. cating at a glance where the focus of infection for any given disease exists.

“6. Various tables and curves are made indicating the contagious status of each school.

“7. Other tables and curves may be made to any extent desired, showing such points as age distribution of contagious diseases, mortality rate, time lost, cost of sickness to family or school, relation to weather or season,

relation to ventilation in home or school, relation to vacations, and relations to any other things which may be deemed important or interesting.

“The relation between physical defects and contagious diseases is a problem which will prove of value is followed out carefully, but it is very difficult to obtain accurate data. ...

"By means of the method indicated I have with the aid of Mr. Ivan C. Hall ... been able to determine some interesting data in respect to contagious diseases in the Berkeley schools. It will be possible ... to summarize only a portion of our results, in the hope that this may prove suggestive to other localities. Our numerous tables and curves will have to be mostly omitted. ...

"The death rate from all causes in Berkeley from 1906 to 1910 inclusive shows an average of 11.8 per 1,000 of population. The total rate has fallen from 15.1 per 1,000 in 1906 to 9.4 per 1,000 in 1910, a reduction of 37.7 per cent. The death rate in Berkeley for 1910 was lower than the average for the state, which was 13.6 per 1,000. . .

“This paper would particularly emphasize the importance of accurately collecting data and exhibiting it as far as possible in a graphic form by means of charts and the plotting of curves. By this means information can be instantly grasped and the problem much more easily solved. Onca facing the situation in any community in respect to transmissible diseases in schools the prophylactic or other measures necessary to put into use may be easily applied."

BOSTON, MASS.

V. 1.

Boston. School committee. Report of the Commission appointed ... to

investigate the problem of tuberculosis among school children. Boston, Printing department, 1909. 11 p. illus. 8o. (School document no. 2, 1909)

“Five thousand is a conservative estimate of the total number of luberculous children in the public schools of Boston.” HARRINGTON, Thomas F. The superintendence of infected children when out

of school and the conditions of their readmission to school. In III° Congrès international d'hygiène scolaire, 1910. Rapports. Paris, A. Maloine, éditeur, 1910. p. 272–82. charts. tables.

Chiefly, in Boston.

“The communicable diseases that are of special consideration in school life fall into three general classes: (1) Zymotic diseases; (2) tubercular affections; (3) contagious skin diseases.

“Medical inspectors and school nurses have done much to datect, exclude, and follow up these soci of infection. Board of health inspection has not availed much in controlling the quarantined cases in the homes. ... A system which promises high results in measures to control infected children excluded from school has been inaugurated in Boston by the district nursing association. Nurses have been appointed for the specific purpose of supervising in the homes supervised cases. . . . She keeps in close touch with the home by repeated regular visits instructing, observing, and guiding the family during the entire period of quarantine. ... This special corps of nurses does not enter the schools but keeps closely informed about school diseases in the district. ...

"In diphtheria quarantine the problem is more difficult. One per cent of well persons carry typical diphtheria bacilli of the morphological type which give a positive laboratory diagnosis. , .

"The belief that scarlet fever and diphtheria are spread by school attendance principally is not supported by reliable data. ... The decline in the morbidity ... starts before the school closure and the increase in the number of cases begins before the opening of the fall term of school. .

“ Tuberculosis is seldom of such a quantity as to require supervision out of school. In an examination of more than 90,000 children in the Boston public schools showing more than 5,000 anaemics, glandular, and undersized children, there were only 150 cases of tuberculosis. . . . Genuine pulmonary tuberculosis, as well as open tuberculosis of bones or skin, should be excluded from regular schools. . . . In Boston such cases are segregated into a hospital school which permits the child to return to

his home each evening." SLACK, Francis Hervey and others. Diphtheria bacillus-carriers in the public

schools. American medical association. Journal, 54; 951-54, March 1910. tables. map.

“An entirely new procedure ... when, acting on the suggestion of Dr. Richard C. Cabot, the school board suggested, under advice of its committee of physicians, the taking of cultures at the beginning

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of the school year from all the pupils in the Brighton district, and the keeping from school of those bond to be bacillus-carriers.”

The estimated number of pupils was about 4,500, just 99 cases, or 1.16 per cent (positive). The author gires the following conclusions:

"1. At least I per cent of all healthy school children are carriers of morphologically typical diphtheria berilli (Westbrook's A, C and D types). 2. Such bacilli are communicable ... and the condition is usually a transient one. 3. The organisms are ordinarily of little or no virulence. 4. While it is possible that by passing through a susceptible individual their virulence might be raised to cause the disease, this is not a frequent occurrench. 5. The disease is kept alive in a community rather by virulent organisms in immune persons than by these non-virulent bacilli. 6. Where virulent diphtheria bacilli are present, as shown by outbreaks of the disease, . isolation of those showing positive cultures is a duty owed to the community. 7. Where the disease does not exist, isolation of carriers of probable non-virulent bacilli is of no proved benefit. ... 8. The attempt to control diphtheria in a city by a round of cultures from all school children at the beginning of the school year does not seem encouraging from this series of tests. 9. The proposition to stamp diphtheria out of a city by cultural tests of all the inhabitants and isolation of all carriers is impossible from any practical standpoint."

CHICAGO, ILL.

Chicago. Department of health. Municipal laboratory. Diphtheria carriers in schools. In its Report, 1907–1910. p. 11-12. table.

"Or 6,468 school children examined during the year 1910, during the diphtheria epidemic of November and December, 744 or 11.96 per cent were at the time of culturing nonsick carriers of morphologically typical Klebs-Loeffler bacilli. ... The largest number of positives found in a single room was 22, including the teacher, out of 25 persons. ... The longest duration of a single case was six weeks. The average time in which the bacilli disappeared from the throat was 8.23 days."

All positive cases were placed in quarantine, and a placard marked "Diphtheria carrier here” was
posted on the premises. “The etfectiveness of the control of diphtheria by isolation of carrier cases
may be judged from the fact that after about five weeks ... the epidemic was effectually stamped
out."

CINCINNATI, OHIO.
BOUDREAU, Frank G. Epidemic poliomyelitis. Ohio State board of health.
Monthly bulletin, 2: 71–78, March 1912.

"The measures adopted by the health department of Cincinnati seemed to me to be particularly
well adapted to our knowledge of the disease and what we can with justice enforce, without being too
arbitrary or too lenient I commend them to your attention.

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""PREVENTIVE MEASURES. **All cases are required to be reported to the health office. Any case of any meningeal affection is investigated, lest it might be a case of infantile paralysis, and any such case that in the opinion of the investigator seems suspicious, is treated as a case of infantile paralysis.

*** The house in which such cases occur are placarded with a sign, stating that there is a contagious
disease within.

**All children connected with a school are removed from school for a period of three weeks.
* * The patients are isolated as much as possible, and especially are children kept away from a case.

*"Those who have been exposed are kept away from children as much as possible, and isolated, with
the exception that "bread winners” are not kept away from their work.

** In case of death the funeral is required to be private and must take place within 24 hours.

CLAIRTON BOROUGH, PA.

COLCORD, A. W. Diphtheria epidemics and the public school. American medicine, D. 8., 7: 245–52, May 1912. illus.

Epidemic in Clairton Borough, Pa., of 22 cases, of which 18 were pupils of the public schools. Features of the epidemic:

"1. Schools were not closed, but children were daily assembled and kept under observation. 2. Syslematic and frequent examination of all throats in the public schools. 3. Cultures taken of all suspicious throats . . . examined at the expense of board of health. 4. Finding of 'diphtheria carriers' and the quurantine and giving of antitoxin to the same. 5. Both cases of 'carriers' occurred in families where several children had been sick and no physician had been in attendance. 6. No case occurred in roun after the inding and isolation of the carriers.' Whole epidemic was soon stopped."

EAST ST. LOUIS, ILL. East St. Louis. Board of education. Medical inspection. In its Annual report, 1910–11. p. 47–48.

“We hope that we may have medical supervision in our schools in the near future. It seems fair and right and the consequent advancement of children when relieved is so much greater and the time spent in school so much less, that the board of education really gains from a money point of view.

"A complete plan of inspection would include (a) an annual or semiannual examination of every school child, with especial reference to: (1) Defects in eyes, ears, nose, mouth, and throat; (2) lungs and chest; (3) spinal system; (4) general strength; (5) nervous force. (6) Daily examination of children who give signs of illness, to prevent the spread of contagious diseases. (c) An annual inspection of the sanitary condition of each school building. Trained nurses to visit the homes of poor children, who are ill, would be a logical part of such a system.” A table of contagious diseases. For teachers and parents, p. 76–77.

Contagious diseases. Table for teachers and parents. (NOTE.-Pupils having any of these diseases are by law excluded from school. A board of health

certificate is required for the first four diseases. In other cases admit to school with physician's certifcate, or sometimes with mother's certificate, in accordance with the time given in this table.)

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Gray or brown patches on ton

sils, white membrane in throat, bloody or irritating nasal discharge. enlarged glands at side of neck, lever sometimes croupy cough: some say may be carried in

clothing Vomiting, sudden fever, red

sore throat, red tonsils, enlarged papillae on tongue, tlushed skin, fine sourlet rash on chest and neck in froin 12 to 36 hours, sometimes pale ring about mouth. Most contagious from scales of skin from ninth to forty. second day Often carried

in clothing. Chill. headache. vomiting.

ains in back, rash like scarlet lever or like measles fourth day rash on forehead.

May be carried in clothing. (Rash, catarrh, slight sever.

Mild scarlet fever resembles

this: be careful. Watering eyes. sneezing, na

sal discharge, cough, sometimes sore throat, rash on back of neck and forehead. small dark red spots, fourth till seventh day; skin peels eighth till thirteenth or eighteenth day. May be car

ried in clothing. Small red pimples on face; vesi

cles filled with turbid serum changing to black or brownish crusts on body or scalp. Smallpox may be mistaker

for this disease. Neck glands swollen, lobe of

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All scabs have dis

appeared,
days after recov:
ery of last case

in family
Seven days after

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ear raised chewing and sour
tastes
painful,

headache, vomiting. depression. Seldom contagious before symptoms appear. 1.arely, ilever, carried in clothing.

swelling and tenderness disappear.

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