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TERMAN, Lewis M. Professional training for child hygiene. Popular science monthly, 80: 289-97, March 1912.

"The sitaation may be summed up in a sentence: The physician's training does not qualify him for the szexy sided lask of adapting the program and environment of the school to the health and grouoth needs of the pupil. The main purpose of this article is to suggest tentatively ... some of the more important lines of professional preparation necessary for those who are to work in any field of child hygiene in the public schools.

"Educational hygiene has four chiel aspects: (1) Medical Inspection,' including routine examinations for physical defects and consequent follow-up service; (2) supervision of physical training, including free play, gymnastics, and athletic sports; and (3) child psychology, including clinical work with mentally and morally atypical children, the hygiene of instruction, etc.; (4) researches in school heating, lighting, ventilation, seating, sanitation and other externals affecting the health of the child. Each of these divisions has of course its logical subdivisions but as only the very largest cities could employ & mora specialized staff than this scheme calls for it is unnecessary to carry the classification further. On the other hand, the majority of school health officers will probably for some years to come have to serve more or less in all these capacities. Assuming, however, the four separate lines of specialization sbove designated let us examine the general and special courses of study which would be necessary for their secessful pursuit.

"To begin with, it would seem that the time requirement could not reasonably be placed bek w soven years in addition to a four year high school course. This corresponds to the usual allotmer t for the doctorate of philosophy and to that for the doctorate of medicine in our sixteen best medical schools. Using the seven-year basis for our calculation, the course falls naturally into three divisions. The first three years would be given to regular college work in which the elements of physics, chemistry, biology, physiology, psychology, paidology, sociology and at least one modern language would be taught. The Daxt three years would be ample time in which to give all that is needful for the school health officer out of the present medical curriculum, besides leaving a fair margin for collateral work in psychology, paidology, and the technical aspects of education. The last year would be reserved for carefully supervised clinical practise in the public schools. Proof of ability to read both French and German should be required a year before the end of the course, for most of the important researches in school hygiene are in these languages.

"Physicians will of course object to the time allotment for the second division. How, they will ask, can you condense a medical course into three years, to say nothing of a margin to be left for psychology and paidology? The answer is more in terms of elimination than of condensation. Pharmacology, bateria medica and therapeutics can be discarded in a lump, with a consequent saving of a full hall year. Doing the same for the obstetrics, gynecology and most of the surgery effects a further saving of three quarters of a year. This makes a year and a quarter off the present medical course. Further, for the purpose here in question, minor savings could be effected in several subjects, as, for example, anatomy, in which the minimum of 400 hours required by the best medical schools could here be taken for the maximum. Finally, the additional year of clinical experience in the schools would take the place of most of the usual courses in the hospital and dispensary, so that almost half of the second three years would be left for psychology, paidology, education, sociology, school hygiene, gymnastic sports, etc., the amount of each being dependent upon the student's choice among the four special lines above Damed: medical inspection, clinical child psychology, physical training and school sanitation. Throughout the course time would be saved and effectiveness promoted by never losing sight of the professional nature of the courses. Physiology, pathology and bacteriology, as well as psychology and sociology, woald bave to be taught in their relations to the ultimate work to be done, not as so many unitary and complete sciences. Even the first three years ought to be conscious of the professional end.

"A school health officer, the product of such a school, would be of far greater service to education than is the usual school physician and would probably be worth more to society in the long run than a dosen well-trained practitioners. At least one such specialist in child hygiene is needed for every 2,000 sobool chüdren. California needs 200, the United States at least 7,000. What university will be the

first to undertake their production?" WHIPPLE, Guy Montrose. The instruction of teachers in school hygiene. Pedagogical seminary, 17: 44–50, March 1910.

Stains of the teaching of school hygiene to teachers: Course outlines; time needed. WINSLOW, Charles Edward Amory. The role of the visiting nurse in the campaign for public health. American Journal of nursing, 11: 909–20, August 1911. Establishment and value of school-nurse work; and the service in homes, teaching “ public health.”

Most hospital training schools are not prepared to meet these new needs. It is absurd to attempt to train the nurses ... for the public health campaign by a course which involves two or three hours a week of theory and 50 or 60 hours in the wards, not hours of clinical instruction, but for the most part a routine of unenlightening and exhausting manual work. ...

The instructive visiting nurse in the public health campaign ... must have a sound grasp of the bilagiral principles which underlie her work so that she ought to have as good a grounding as the medkcal oun ta the fundamentals of physiology and bacteriology and hygiene; and ... she must be acquainted with the broad outlines of sanitation and sociology... We may emphasize as necessary

the provision of special graduate instruction for nurses specializing in these various lines." WITMER, Lightner. Clinical psychology and the professional training of teachers

(and others interested in child welfare) In his The special class for backward children. . . Philadelphia, The Psychological clinic press, 1911. p. 262-75.

See also under the teaching of health and hygiene. Meylan, George L. Report of the committee,



AYRES, Leonard P. Salaries of medical inspectors in America and in England.

Journal of education, 70: 149–50, August 19, 1909. [GULICK, Luther Halsey) Salaries of medical inspectors. Pedagogical seminary, 19: 225–27, June 1912. chart v.

No salary, 75; $1 to $100, 47; $101 to $200, 50; $201 to $300, 44; $301 to $400, 25; $401 to $500, 24; $501 to $600, 18; $601 to $700, 2; $701 to $800, 12; $801 to $900, 6; $901 to $1,000, 13; $1,001 to $1,500, 18; $1,501 to

$2,500, 7; $3,501 to $4,000, 3. Fee according to service, 19. From article by Louis B. Blan. GULICK, Luther Halsey and AYERS, Leonard P. Salaries of medical inspec

tors and the number of pupils per inspector. In their Medical inspection of schools. New York, Charities publication committee, 1908. p. 1, 23, 139–49. table.

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Boston, Mass..
Brockton, Mass.
Camden, N.J.
Chelsea, Mass.
Detroit, Mich.
Lawrence, Mass.
Montclair, N.J.
Nowark, N.J.
New Haven, Conn.
New York, N. Y
Paterson, N. J......
Seattle, Wash
Somerville, Mass.
Springfield, Mass.
Woonsocket, R, I..
Worcester, Mass...

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86, 839 7, 781 9,718 6,047 37,757 7,539 2,503 38,562 18, 135 523, 084 15,238 16,174 11, 166 10, 605

2,862 18, 273

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200 2,400





1,085 1,111 9, 718 2,015 1,398 7,447

625 2,410 3,627 3, 151 5,168 1,470 1,581


477 1,218


1,400 2,400

600 6, 750 1,500 1,220 6, 400

1, 200 199, 200


201 .487 . 165 .066 .380 .251

11,500 31,200 11, 200





.445 . 126 .259 . 104 . 164


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· Ten. TERMAN, Lewis M. (Salaries of California school physicians) Psychological clinic, 5: 58, May 15, 1911.

Pay of school health officer varies from $100 to $3,600 per year. Hall-time workers (excluding nurses) receive from $400 to $1,600, full-time workers from $1,500 to $3,600. Two of the smaller cities pay the physician for each individual pupil, 50 cents in one case, $1 in the other.




Birmingham public schools. (Superintendent) Report of Medical director. In his Annual report, 1911. p. 27-37. illus.

Signed: James S. McLester, M. D.

Each teacher keeps upon her desk blank cards (fig. 1) upon which she notes anything unusual she detects in a child; when these cards are filled, she gives them to the principal who keeps them until the next visit of the medical director, who in a room set apart for the purpose, examines all those pupils whose record cards have been given him. Communication with attached return postal is sent the parent explaining case and advising that physician be consulted, or the child taken for free treatment to the dispensary at the Hillman hospital; parent is requested to take this notification to the physician or hospital as case may be, and a reply from the physician is to be written upon the return postal card. This reply is noted on the child's original card, which is then filed in an index system. In cases where Do physician's reply is received, the nurse visits the child's home, and her data are added on the record card, before its final filing.

Study of 10 elementary white schools (enrollment of 5,343) was begun in March 1911. Results 1. Temporarily subnormal, 192. II. Permanently subnormal: (1) Morons, 33; (2) imbeciles, 10; (3) idiots, 4. III. Truant and incorrigible class: (1) Defective mentality, 16; (2) fair mentality, 51. IV. Epileptic class, 4. V. Physically defective: (1) Physical trouble, temporary or permanent, 347; (2) the blind, 3; (3) the deaf-mute, 0.

In the Paul Hayne school a dental clinic cares for the defective teeth. Central high school has an emergency hospital (see picture. p. 28).

Samples of cards used by the department of medical inspection, p. 35-36.


(LOPER, John D.) Medical inspection of school children. Made by competent physician, employed by the board of education.

Letter, signed John D. Loper, superintendent, to U. 8. Bureau of education, Division of school hygiene.

If child is found to have any infectious or contagious disease, he is sent home with a notice to parent stating the case and asking that he be given treatment by physician of their own choice; readmitted to school only upon certificate of school physician. “About 8 per cent of our pupils have trachoma. Elghty per cent of the children so affected are among our Mexican population and fully 90 per cent of these children have no means of securing treatment. Hence, our greatest problem in this connection is to provide some means by which our indigent children may be treated for this disease."

CALIFORNIA California. University. Statistics of the infirmary. Medical examination of

new students, 1908–9, 1909–10. In Biennial report of the President, 1908–1910. Berkeley, The University press, 1910. p. 329–61 (tables only)

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LESLIE, George L. Health and development supervision of the public schools of California. Western journal of education, 15:17-25, January 1910.

Assembly bill No. 303, p. 25-26.

Also in Sierra educational news, 6:27-34, February 1910; and with some verbal changes, in Psychological clinic, 4:33-39, April 15, 1910. TERMAN, Lewis M. Medical inspection of schools in California. Psychological clinic, 5:57-62, May 15, 1911.

Legislature, March 1909, "passed bill authorizing (not compelling) cities to make expenditures for carrying out an elaborate system of health supervision in the schools."


HOAG, Ernest Bryant. The cooperation of school health departments with other health agencies. California State journal of medicine, 9:18-19, January 1911.

Also in American academy of medicine. Bulletin, 12:36-39, February 1911.

The medical clinic organized in Berkeley after the San Francisco fire of 1906, was reorganized with statř of 15 representative physicians. The Berkeley charity organization joined with the medical clinic, and the two associations housed in a building near the school and city health department. The Alameda county dental society organized two dental dispensaries, one for Oakland and one for Berkeley, completely equipped in modern dental necessities. The board of education at once placed at the disposal of the Berkeley dental dispensary, offices in connection with those of the medical director of schools. The Red Cross and Tuberculosis societies will also cooperate with the others, and Berkeley will have united toward one common and the efforts of the following health agencies: (1) The school health department; (2) the city health department; (3) the charity organization; (4) the medical dispensary; (5) the dental dispensary; (6) the city charity commission; (7) the Red Cross society; (8) the tuberculosis

society. HOAG, Ernest Bryant. A general plan for health supervision in schools. California. State board of health. Monthly bulletin, 5: 173–78, February 1910.

of the first 750 children referred to the school physician by the teachers in Berkeley, Cal., nearly 70 per cent were found to be in need of medical or dental attention. Of 493 children in the third to the eighth grades inclusive, 53 per cent used tea or coffee or both daily. Of the 493 children, 25 per cent habitually slept in un ventilated bedrooms.


LESLIE, George L. Department of health and development-Los Angeles city

schools. California. State board of health. Monthly bulletin, 5: 180–85, Febru

ary 1910.

"(@) All matters pertaining to contagious diseases are under the direction of the city board of health, which employs a staff of physicians and school nurses to attend to this work.

“(6) All matters pertaining to non-contagious defects-to health, growth and development of pupils and teachers, are under the control and direction of the board of education, and conducted in accordance with the health and development law of California."

Los Angeles staff examines approximately 50 per cent of the pupils of each school building, selecting: First-Pupils who failed to be promoted. Second-Pupils, two, three or more years behind schoo! grade. Third-All pupils selected by principals and teachers as needing medical aid (glasses, surgery, etc.). Fourth-All pupils of low vitality, unduly nervous, pupils not getting on well in their school work, pupils who need an unusual amount of discipline, of those with criminal tendencies, etc. Fifth-AU applicants for positions as teachers in the city schools undergo physical examination by the staff. AU




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teschers in the schools report for examination when requested by the superintendent's office. SirthEspecial examination is given to exceptional children. Seventh-School buildings are inspected by the stall. Eighth-Follow-up-work is carried on by the staff, by principals and teachers of the schools. The following is a summary of examinations of Los Angeles city schools:

Approximate summary of ten months' examinations.

A. All pupils examined by staff. Enrollment of schools when examined...

6,647 Number hastily passed upon by examining staff.

2,808 Number thorough physical examinations.

3, 846 Report of physical examination. Namber defective in eyesight....

2,012 Notices sent to parents.....

1,112 to be watched by teachers and examined further if pupil's health or school work indicates further examination. Number defective in hearing..... Notices sent to parents...

175 Most of the defective hearing is due to adenoids and diseased tonsils and lack of care of the nose and threat. For this reason special notices of defective hearing were not sent to parents where the cause was otherske clearly indicated. Number defective sets of teeth..

1,395 Notices sent to parents...

1,395 Adenoids present...

1,322 Notices sent to parents.

6,670 652 to be watched by teachers and reëxamined il defective hearing or lowered vitality indicate such examination. Number abnormal and diseased tonsils....

1,517 Notices sent to parents.....

688 cases to be watched as in case of adenoids.

Poor lung action and chest development; hard to judge accurately.
Functional heart insufficiency...
Notices sent to parents...
Organic heart disease......

B. Special pupils only examined. Report of physical examinations of pupils, selected by teachers and examiners, because the need of examination was indicated by poor health, lowered vitality, or poor school work-all pupils undergoing the physical examination by examining staff. Notices sent to parents in almost all cases, Namber examined.

1, 129 Defective in eyesight.,

434 Defective in hearing.......

259 Defætive teeth.

446 Adenoids present. Atpormal and diseased tonsils.

332 Functional heart insufficiency. Organic heart disease...

The above pupils were pupils especially selected from different buildings, of ungraded rooms, or of the special schools, or of the deal school, or office examinations.

Total number examined for the year, 7,776.

Report of defective growth and vitality and school work accompanying these defective pupils is hard to make. It is mostly measured by the number of repeaters in the schools, by considerable sickness and disease, and by more or less inefficiency and degeneracy.

Report of health elaminations of teachers for positions in the city schools. Number of teachers examined..

107 General health below average: hard to judge accurately. Error in vision uncorrected, 25; wearing glasses, 23.... Hearing below normal (slightly). Throat only fairly healthy. Punctional heart disturbances. Organic heart disease..

5 Lang action below normal. Disturbed digestion.. Slight pelvte weakness.. Nerve lorce reduced (somewhat)...........

Sooner or later the main data which enter into the intelligent handling of pupils must depend to a greater or less degree upon physiological age, the physical and mental endurance of children and youths; the character and kind of work should be adjusted primarily to physiological, not chronological age.



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