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Report of medical inspection of backward, defective, and mentally defective children of the

public schools of Cleveland, Ohio.

Classification.

Chrono-
logical
age.

Psycho-Number
logical exam-
age.

ined.

Per cent.

40

Idiots and low imbeciles...
Middle and high imbeciles.
Low and middle grade morons.
High grade morons.
Three years retarded.
Two years retarded..
One year retarded:

7 to 16 9 to 17 12 to 16 16 to 17 6 to 15 6 to 14

3. 10 10.92 20.84

Chronologically normal.

Psychologically normal. Above normal.

2 to 4 5 to 7 8 to 10 11 to 12 3 to 12 4 to 12

140 267

22 281 275

1.71 21.92 21. 46

6 to 13
6 to 11

5 to 12
6 to 11

213
41
2

16.62
3. 20
.LS

Total number examined..
Total number of feeble-minded.
Total number of leeble-minded and border-line cases.
Number now in special classes..
Number now in boys' school.

1, 281

469 750 302 131

Cleveland. Superintendent of schools. Medical and dental inspection. In his Annual report, 1909. p. 70–72. table (results in two contrasted schools)

Examination of 30,000 children in grades III to VII, year 1906–7, by the Department of physical training, with respect to condition of eyes, ears, nose, and teeth.

In one school in “congested” district contrasted with results in “East End” school.

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In March, 1909, of 36,403 children examined, the teeth were found to be defective of 27,918.

“Though the Cleveland schools have never enjoyed a complete system of medical inspection, the department of health, through its ward physicians, protect the schools from infectious diseases. In addition, under the general direction of the school physicians, there have heen located in schools in foreign districts, six school dispensaries, five of these being established this year. . . . At each is stationed

a school nurse; ... a new feature of this year.” Cleveland chamber of commerce. Report of the Municipal sanitation committee on medical inspection in the schools. 10 p. 8°.

Approved by the Cleveland chamber of commerce, February 23d, 1909.

Historical sketch, and argument for medical inspection based on Superintendent's report for Cleveland schools, 1907: “That the schools are suffering a great economic and moral waste. ... 8,595 children, 13.3 per cent of last year's enrollment, were three or more years behind their grade. At the estimated tuition cost of $26 per enrolled pupil per year, this number represents a dead loss per annum of $223,470. It is estimated that less than one-tenth of this sum will provide an adequate system of medical supervision. If such a system resulted in the saving of only one grade to not more than one in ten of these

backward children each year, it would prevent a greater waste than it would cost.” McHENRY, Junius H. Medical school inspection in Cleveland. Cleveland medical journal, 8: 338–46, June 1909.

Also in Ohio State medical journal, 6: 641-45, December 15, 1910., Title: Medical inspection of schools.

In March 1906, the board of health appointed 26 physicians to attend the indigent sick and to inspect the public and parochial schools. The ward physicians organized themselves into the Cleveland medi cal school inspectors association; redistributed assignments of schools, effective in 1907.

Each inspector visits each of his schools daily. During school session, monthly meetings are held by the inspectors and representative medical men and specialists, to discuss conditions and present addresses.

“Cleveland has installed a system which, I believe, does not exist in other cities, namely school dispensaries. These are situated in the congested foreign element districts of the city. Two such dispensaries are now used and others are being equipped. It is the intention of the board of education to establish others ... where they are most needed. A graduate nurse of the visiting nurses association is in charge and is under the instructions of the school inspector. ... After school hours the nurses are required to visit those children who were absent, on account of exclusion. . . . As a result 90 per cent of the children that otherwise would have been excluded, are enabled to continue in attendance. without exposing any of the associated children to the dangers of infection.”

Treatment is given at these dispensaries for emergency cases only. A card system is in operation, "intended to follow the child through its school life and the information is confidential for the boards

of health and education,” regarding the home and health conditions found in investigation. WALLIN, John Edward Wallace. Medical and dental inspection in the Cleveland schools. Psychological clinic, 4: 93–108, June 15, 1910.

Bibliography: p. 108.

Between the school nurse and the dispensary of one school alone, 1,871 days in school were saved for children who otherwise would have been excluded. As a result of this hygienic and medical work the attendance records have reached unprecedented heights in these irregular stations."

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.

The findings were about the same as those of other cities. Fifty per cent or more had defective teeth; 30 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 on 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 allotted 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 acts 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 teachers 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.

“2. 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 number routine examinations.

7,504 Total number showing some defect..

2, 423 Defective vision...

677 Defective hearing.

143 Defective teeth....

187 Hypertrophied tonsils.

805 Adenoids..

432 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 the general health of the school inmates...

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

to

p. 313.

KEEN, Edwin L. Medical inspection and precaution in the schools. Pennsyl

vania 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, 0.281; defective vision, 14.83; defective nasal breathing, 5.27; defective hearing, 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 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.

“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...

351 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..

1,554 Atrophy of teeth. Mouth breathing.

236 Putrescent pulps.

1,894 Exposed pulps.

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

733

925

308

RHODE ISLAND.

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

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 hay, 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 is 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: Ellen 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.

“In 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 examiners; (2) a record card kept by the school authorities; (3) a notification card sent to the parent.

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