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KNOPF, Siegmund Adolphus. Dental hygiene for the pupils of public schools. New York medical journal, 96: 617-21, September 28, 1912. tables.

Reprinted

A report on the facilities offered by New York public dispensaries for the dental care of school children. Letter sent to superintendents of the 34 important general and special dispensaries, asked four questions as follows:

1. Does your dispensary have a dental department?

2. If so, how many dental surgeons are in attendance, and for how many hours a week and at what time are they engaged in giving their services?

"3. Do the patients have to pay for the material for filling teeth, etc., or is it given gratuitously?

“4. If there is no dental service attached to your dispensary, would you be willing to establish one and arrange special hours for school children so that the time for visiting the dispensary may not conflict with school hours?"

The 33 answers appear in full in the report, of which the following is a summary: Have dental facilities.

15 Have no dental facilities Are willing to establish dental department.. Are unwilling or unable to establish one. Have asked for suggestions with a view to establishing one. Do only extracting. Do also filling Do work gratuitously, or charge those able to pay Charge for material used. Have hours suitable for school children Have hours unsuitable... Are willing to increase or change hours. Are unwilling or unable to change hours.

To the report comprising sixteen dispensaries independent or attached to hospitals, we must add that there exist three dental clinics maintained by the Children's aid society, kept fully employed with the care of the teeth of the children attending the society's schools. There is also one free dental

clinic, being the health department's institution. Rochester. Board of education. (Dental clinic established in the school building no. 14, by the Rochester dental association) In its Report, 1908–1910. p. 21, 22, 73.

In operation since February 23, 1910; probably the only school dental clinic in the world, in a school building. For the benefit of children of parents unable to pay for dental work. Permission granted to the society to open a second dispensary at school No. 26.

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OHIO.

Cleveland. Board of education. [Report of the oral hygiene experiment made in the Marion school] In its Official proceedings, February 27, 1911. p. 44-59.

See also p. 42-43.
Reports of the oral hygiene committee of the National dental association, and others.

“With 97 per cent of the public school children in need of care and treatment, and with the worst oral conditions showing an improvement of from 374 to 50 per cent in working efficiency, would it not be conservative to consider that with all ... the mouths in good first class condition that there might be an average increase of at least 10 per cent in working efficiency for all the children in the schools?

“The records of 1909 and 1910 show a registration of practically 65,000 pupils in the elementary schools and ... we would show an expenditure of $170,625 a year to educate children handicapped by faulty oral conditions; but, in making the above estimate, our committees placed their percentage at a figure which they are positive is less than half of what actual tests would show. And, if we double the above amount we find that we are spending $341,250 per year to overcome the handicap of faulty oral conditions."

See also: Tabulations of the effect of dental care on the mental powers of the dental class, in Marion
school, Cleveland, Ohio. Dental brief, 16: 779-782, October 1911.
EBERSOLE, W. G. A school “educational campaign" for oral hygiene of the
National dental association.

Abstract of a lecture.
Abstract in American school board journal, 41:17, 18, 32, 34–35, 38, November 1910. Report form,

"In the public school, our educational system proposes, first, to make a cursory examination of each child, sending into the home a record of that examination, and bringing the parent or guardian a knowledge of a faulty oral condition. ...

“The second step ... is to put into the schools, when the examiner has finished and the parents and pupils are prepared for them, a system of lectures which explains the purpose, use, care and and treatment of the mouth.

"Third ... is the establishment of the dental clinic ... to make possible the securing of data whieb will show the value of the healthy oral conditions as related to the working efficiency of the child from the economic side of the question . . , from the school reports of the pupils, preceding and following treatment."

In the Cleveland, Ohio, Marion school, an experimental class was formed, of 40 boys and girls selected ss having the worst oral conditions of all the pupils. Their school records for the six months preceding the test were taken, two psychological tests made before we began our work; the children furnished with toothbrush and powder and a dental nurse placed over them. Test meals given, the teeth all treated and filled, and a $5 gold piece offered as prize to each child faithfully carrying through the conditions of the test. Two psychological tests will be made during the time of test: and two will be made during the six months following treatment, with the school records, “and from these records it is expected to secure evidence which will show the value of dental service in dollars and cents.”

NOTE:-For results, see following references. Report of scientific experiments conducted in the Cleveland public schools for the

purpose of ascertaining the value of healthy conditions of the mouth. Experiments conducted under the auspices of the National dental association, the Ohio State dental society, the Cleveland dental society and the Cleveland board of education. Cleveland, Ohio, Published and distributed by the National mouth hygiene association, April 1, 1912. 35 p. illus. tables. 8°.

Chairman of Oral hygiene committee of the National dental association, W. G. Ebersole, M. D. In June 1909, 10 dentists and 10 nurses or attendants, began the inspection of the mouth conditions of the 816 children of the Marion school, Cleveland; out of the 846, but 3 were found to have teeth in perfeet condition. Out of the entire number of dental charts, 40 were selected, as representing the worst mouth conditions, for the experiment. (1) They were to have their teeth put into perfect condition, (2) They were to brush their teeth carefully three times a day. (3) They were to masticate their food properly, not using liquid with solid food. (4) They were to attend any and every meeting of the class called and to conform to regulations laid down.

Ia mental efficiency the children made gain of 99.8 per cent shown by psychological tests, one given in May, one in June, one in August and one in September, 1910; last two given on the 4th and 10th of May 1911. Longest time spent on one phase of the work during a test, was less than three minutes. The children who needed the improvement most were the ones who made the greatest gains.

Individual records given. WALLIN, John Edward Wallace. Experimental oral euthenics: An attempt

objectively to measure the relation between community mouth hygiene and the intellectual efficiency and educational progress of elementary school children. Dental cosmos, 54: 404-13, 545-66, April, May 1912. tables. graphs.

Reprinted.

"The conclusion is strongly suggested that the desirability of establishing dental clinics in the public schools, for free inspection and treatment, should present itself to the taxpayer as a plain business proposition; ... the paying of proper dividends on the capital invested in the schools. ...

"We started out with a class of retardates and repeaters. During the experimental year only one of the 27 pupils failed of promotion. According to the best estimates there are 6,000,000 retardates (pupils over age for their grades) in the public schools of the United States. ... About one-sixth are repeaters (pupils who must spend more than one year in one grade). It costs the country annually $27,000,000 to educate every sixth child over again; i. e., a second, third, or fourth time in the same grade. (Ayres)

" During the experimental year not a single truancy card was made out to these 27 pupils. ... On the psychological side, the class showed an improvement ... which amounted on the average to about

per cent. That a large part of this increased efficiency was directly due to the mouth orthogenics is attested by the parallel pedagogical improvement made by the pupils. ... An efficiency improvefpent of 10 per cent ... would amount to one school year in ten ... and in the aggregate would save

taillions of dollars annually to the taxpayer." WALLIN, John Edward Wallace. Experimental oral orthogenics: An experi

mental investigation of the effects of dental treatment on mental efficiency. Journal of philosophy, psychology and scientific methods, 9: 290–98, May 23, 1912.

The Cleveland experiment annotated elsewhere.

PENNSYLVANIA.

HARRER, W. F. Oral conditions in children as causative factors in disease. Dental cosmos, 51: 196-200, February 1909.

Examination of 247 public school children, Monioursville, Pa. Of 51, ages 6 and 7 years, but 8 had sosolutely perfect first permanent molars. Of a total of 1,036 deciduous and permanent teeth, 436 were detective; in 25 children the number of defective tæth exceeded the intact teeth; & children used toothbrush daily, and 4, occasionally.

In the 86 children, ages 8 to 11 years, of a total of 1,781 teeth, 627 were carious, about 1 pupil out of every 7 used the toothbrush daily.

In the 110 children, ages 11 to 15 years, of a total of 2,616 teeth, we were defective; toothbrush used occasionally by the majority of the children. In 25 of them, from 2 to 4 first permanent molars were decayed beyond help; 15 had good first permanent molars, Dearly all filled, as well as the full number of teeth for their respective ages.

Those children whose deciduous teeth had received attention, showed healthy mouths, and “as far as could be learned, they possessed keen mental development. ...

"In the children examined a number gave evidence of toxic infections. They were pale, listless, apathetic, gave a history of headache, and were unable to cope with their studies. In some pupils ... from 1 to 3 years behind their proper grade, actually repulsive conditions of the mouth existed. These unfortunates were being deprived of their measure of education, besides endangering the health of the

school by reason of their susceptibility to infeetious disease.” McCULLOUGH, Piercy B. The Southwark school dental dispensary. Teacher, 16: 133–35, May 1912. illus.

Opened, January 22, 1912, a “municipally operated dental dispensary" in the school. The volunteer organization of dentists, rendering service for 15 months at the city hall (opened, Oct. 5, 1910) were succeeded on January 1, 1912, by a paid corps of eight legally qualified dentists, each serving one-half

of every working day. (Pittsburgh) Dental and oral hygiene in our public schools. Pittsburgh school bulletin, 3:24-25, May 1910.

of the 732 children examined in two public schools, 9 mouths found in good condition; 2,909 diseased teeth; 3 children who used toothbrushes. Reading. Board of education. Dental inspection. In its Annual report, 1910 1911. p. 11-12.

The Reading dental society, 1910, detailed 25 of its members for the inspection—8,925 pupils being examined. Less than 3 per cent were found to have perfect teeth, only 4,849 had ever used a toothbrush, but 1,369 had ever been to a dentist, and 1,094 had had permanent teeth extracted. Permanent teeth cavities to the number of 28,548 were found.

In 18 months the free clinic treated the teeth of 275 pupils.
The Reading free dental dispensary is the first reported in the State of Pennsylvania.

Work of the Reading dental society, operating successfully for three years, a free dental dispensary.
Examination was made of the mouths of the first grade public school children, with results as follows:
Number examined.

2,010 Green stain...

1,436 Gums abnormal. Mouth breathers. Cavities in permanent teeth.

2,907 Number of putrescent pulps.

1,162 Number of exposed pulps.. Use of toothbrush...

796 (Tables with letter from Dr. H. W. Bohn, dated August 21, 1912, U.S. Bureau of education, Division of school hygiene and sanitation.) SCHLEGEL, George S. The Reading free dental dispensary. Psychological clinic, 3: 249–54, February 15, 1910.

Organized by the Reading dental society, the first man reporting for duty on June 2, 1909. In less than five months, with two of unavoidable delay, the Free dental dispensary was founded, equipped and paid for. Equipment is modern in every particular. The patients are received through the Asso ciated charities, from the public schools, and the general public, the teachers being provided with blanks to be filled out by them for school children. Hours, 9 to 12; 2 to 5; Saturday afternoons excepted.

Dental inspection to bogin in the public schools with the September session, 1910.

93 140

580

PHILIPPINE ISLANDS. OTTOFY, Louis. Dental clinics in Manila: Schools, prison hospital, and orphanage. Dental cosmos, 52: 887-93, August 1910. tables. Bibliography: p. 893 (of author's own papers and reports)

First free dental clinic in Manila, January 1904 (Report in Fourth International dental congress, Transactions, 1904) maintained in connection with St. Luke's hospital.

The school clinic, begun January 10, 1910, "is conducted absolutely without cost to the pupils and the school authorities. ... The work is commenced at hall-past seven or eight in the morning, when

I enter a schoolroom and ask the teacher to request all the children who have the toothache to rise. ... These go to the operating room and are attended to....

"The reports of tho work as it progresses aro daily brought to me by the assistant, who occupies a maant room in the school building, and who operates from 7.30 until 12, and sometimes until 1 o'clock.

"All these clinics, except the one in the schools and that lives by reason of the others-are connected to violation of law, but ... under a provisional sanction. ... I have made repeated efforts since 198 to have the law amended so that (at first) such clinics might be established, and (since 1906) when they were established, that they might continue—but without success. ... The donations to the cánie are valued at about $900. ... My own services are given without remuneration. ... The hospital gives quarters to the clinic free of rent." See also Dental cosmos, October 1911 and November 1912. Philippine general hospital is establishing a dental clinic to be in charge of author.

RHODE ISLAND.

COLTON, James C. The dental condition of children in the Providence public schools. Dental cosmos, 51: 876–80, July 1909.

"Or 1283 children examined, 1161, or 96.6 per cent had decayod teeth and 557 or 46.3 por cont had muffered from sching teeth within two weeks. ... In the technical high school, where 100 young men Pere examined, 96 were found to have decayed teeth. . . . 01 the 1203 examined, only 19.2 per cent Died a toothbrush at least once a day; 37.7 per cent used a brush not less than once a week but not as often as once a day, and 43.1 per cent never used a toothbrush.

"Believing that nervous diseases and lowered vitality (due to abnormal oral conditions) contribute to a low standard of scholarship, I visited the ungraded rooms at the Benefit Street and the Chalkstone Arenne primary schools and there examined 39. ... I found that every child had decayed teeth ranging in number from one to ten; 23 had aching teeth; 19 had been disturbed while sleeping by aching teeth within two weeks, and 14 could not eat without pain from carious teeth.

"I believe ... there are over 27,000 public school children (in Providence) in need of immediato sttention, and if 46.3 per cent of the public school children are suffering from toothache, there are 13.000 whose nerve condition is abnormal and who cannot reasonably be expected to attain a satisfactory standard of scholarship.” Providence. School committee. (Report of the Dental inspector] In its [Proceedings) no. 40 (Series E] February 23, 1912. p. 434–35. The first year's work, ending January 26.

An examination of 4,418 children, "of whom 4,131, or 93 per cent, were found to have decayed teeth; 29, or 6.5 per cent, had sound teeth; 1,083, or 24.5 per cent, were found with aching teeth. Only 189 children out of 4,418, or 4.3 per cent, had received dental treatment previous to the examination. As a result of the examination and recommendation to the parents, 1,009 children, or nearly 24.4 per cent of all those whose teeth needed attention, have received 3,430 dental treatments--an average of ovor three treatments to each child."

THE SCHOOL NURSE.

GENERAL REFERENCES.

ALLPORT, Frank. The school nurse. American academy of medicire. Bulletin, 13: 145-50, June 1912.

"It is, of course, desirable that each nurse shall have but few schools to care for, in order that individual necessities shall be relieved in the best manner possible. No nurse should have under her care more than 1,000 pupils, indeed, one nurse can hardly care for more than one school and do her work satisfactorily, and I greatly question whether even this is not too much labor to expect of any one woman.

"This opinion can perhaps be better understood, if an effort is made to acquire some i !ea of the multitodinous duties of the average school nurse. In the first place she shall act as first assistant to the medical inspector, and shall always be in attendance when he makes his visits to the school. By observation and consultation with the teachers, she finds sick and ailing children and submits thom to the inspector. The carrying out of the inspector's orders is placed in her hands, whether this is done at the school, home, or tespital. Many cases of skin diseases, lico, filthiness, etc., are cared for at the school by the school murse, under orders from the medical inspector, and in schools possessing bath tanks, etc., they are operated under the supervision of the school nurse. One of the principal functions of the school nurse is to me that the doctor's orders are carried out. The doctor may diagnose and prescribe, but unless his sisia is followed his work is useless. This important duty is performed by the school nurse. It must be remembered that many public school children are poor children, whose parents are either busy, negligent, impoverished, dissipated or ignorant. They probably have no money with which to purchase melkeines, appliances, glasses, medical, surgical and hospital services, etc., and all these things the school

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nurse undertakes to supply by drawing upon the resources of charitable funds, charitable people, charitablo hospitals and charitable doctors. These poor people are sometimes apparently dovoid of energy, and have to be cared for with but little confidence in their intelligence. The school nurse then has to secure the modicine and see that it is properly administered. Cleanliness, bathing, properly prepared food, sanitation, ventilation, plumbing and warmth come under her supervision. She takes children to doctor's offices, dispensaries, hospitals, etc., and sees that they get home again. She carries out the doctor's orders at home, such as giving medicines, syringing ears, using eye-drops, making surgical dressings, etc., she cooperates and works with the truant officer in keeping children in school. In short, through her assistance the doctor is able to prescribe or operate with the confident feeling that ... his directions will be followed as far as is humanly possible by the already over-worked school nurse, in cooperation with her equally praiseworthy but overburdened sister, the visiting nurse of the district. Before these commendable institutions came into existence thousands of able operations were virtually thrown to the winds by poor post-operative attendance, and enormous stores of good medical advice mullified by neglect and improper living. The school and visiting nurse have become, then, the element which has transformed doubtful results into reasonably certain good results.

“The school nurse not only comes into contact with the school child, but also naturally and inevitably mingles with the school child's family, and here she performs a most important function, not only to the child, but to the family and to the community as well. By calling upon the family to look after the welfaro of the school child, she and the district visiting nurse, if necessary, will endeavor to educate the family to ideas of cleanliness, honesty, sobriety, industry, kindness, cooking, ventilation, infant welfare, etc., in all of which departments of proper living there is abundant opportunity for missionary work among the thickly populated tenement districts of our large cities. This is a department of charity which, unfortunately, will nover be overdone, and the extent of its usefulness is only outlined by the amount of money that is eligible for the purpose. I believe there is no charity which furnishes such extensivo results for the money subscribed as the visiting and school nurse, and no object for which people may so safely and blindly contribute financial support as the one under consideration; every dollar given

helps to make individuals and communities better, healthier and happier." CARLEY, Margaret E. The school nurse as a link in the chain of preventive

medicine. In American school hygiene association. Proceedings, 1912. Springfield (Mass.) American physical education review, 1912. p. 33–40. table. insert.

Contains an outline of a plan for the development of school nurses' work, prepared by the writer, Dr. Carley, Department of hygiene, Boston public schools. CORNELL, Walter Stewart. The nurse as a municipal officer. Psychological clinic, 4: 181-88, December 15, 1910.

Reprinted with some omissions and some new paragraphs and nurses' records in his Health and medical Inspection of school children . . . 1912. p. 82-87. Title: The school nurse.

Article is chiefly the work accomplished in Philadelphia.

"There is no question as to the value and propriety of the nurse's services in treating minor skin discases of a contagious character. ...

“It is a fact, however, that the major portion of the nurse's work in the school building has como to be the treatment of minor cuts, bruises, and infections. ... This relief so freely and so gracefully given is in reality dispensary work.

“The chief business of the nurse is (a) to shorten or obviate the period of exclusion from school of children suffering from minor contagious diseases, and (b) to secure the correction of physical defects by reason of personal interview with the parents. ... A certain proportion of the nurse's work as at present carried on is unnecessary and, therefore, an extravagance. Thousands of bruises and scratches are "treated' which are so trilling and superficial that the act is a travesty on medicine. ...

"Similarly, the “treatment of pediculosis, recorded as almost a third of the nurse's work, is seldom actual treatment at all. It is simply advice. Probably not 1 case in 20 requires a homo visit and not 1 case in 50 an actual head scrubbing."

Dootor Cornell says further:

“The results of the school nurse's work are remarkable. Contrasting the work of the medical Inspector working without a nurse with that of an inspector working with a nurse, the economy . . , in amploying the nurse is easily manifest.” See regarding New York City, p. 76, of the book.

“There are 281 nurses employed in the division of child hygiene of the department of health, (Now York City) and there are 55 additional nurses employed for five months during the summer, working from the 1st of May until the 1st of October.

There are, however, a number of nurses employed in the division of communicable diseases and the division of contagious diseases of this department.” (Excerpt from letter, dated Aug. 19, 1912, signed by John J. Cronin, M. D., assistant and acting director of child hygiene, to U.S. Bureau of educa. Hon. Division of school byglene)

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