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HINES, E. A. A plea for medical inspection of school children in South Carolina

Report of the work at Seneca. South Carolina medical association. Journal, 6: 454-57, September 1910.

“The Seneca schools are the first in South Carolina to put in operation the modern idea of medical inspection," beginning September 23, 1909. Staff of examiners: Two competent dentists, an eye and ear, nose and throat specialist, two general practitioners, and a secretary; 200 children, ages 6 to 18, pupils first to tenth grades, examined. Children having

Number. Defective teeth..

153
(Number of teeth, 600.)
Defective tonsils.
Enlarged glands.
Adenoids...

(Number of suspects.)
Eye defects...
Nasal defects.
Skin lesions.
Orthopedic defects.
Teeth brushed daily...

170 "I can not find any report on the negro school child in the South. I examined a representative number and found in general faulty nutrition, practically all with teeth defects--contrary to the idea that prevails. Fewer serious tonsil defects compared to the whites, more skin lesions. I did not examine for adenoids. A fair proportion had used the tooth brush.

“I also examined a representative number of cotton-mill children among the whites. Ninety per cent had bad teeth--not one used a toothbrush." South Carolina. State board of health. Hookworm disease. In its Thirty-first annual report, 1910. p. 15–18. table.

From October 1 to December 10, 1910, in five counties, 4,695 children were examined clinically; 80, microscopically; 165 cases treated; 47 per cent gave clinical evidence of being infected with the hook

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worm.

South Carolina. State board of health. Medical inspection of schools. Its Monthly bulletin, 1: 3—29, October 1910. tables.

“The Southern States have been behind almost all the rest of the countries of the civilized world in introducing medical inspection of schools. ...

“New Orleans was the first Southern city to take active steps in this direction in 1908, and Atlanta, in 1908 and 1909. In South Carolina the complete modern idea of medical inspection of schools was inaugurated in the Seneca graded and high schools, September 23, 1909. . . . The examination (was) conducted by two general practitioners of medicine and surgery, two dental surgeons and one eye and ear, nose and throat specialist, a secretary and the teacher of each grade.”

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of the defects discovered among 200 pupils, “children of the very best and most prosperous citizens of the Piedmont section," were: Glands enlarged.. Eye defects. Teeth defects.

153 Tonsil defects. Not vaccinated.

168 “A representative number of children of the ecit.n mill and negro schools disclosed a much greater number of defects.” (South Carolina] The veto of the Medical inspection bill. South Carolina medical association. Journal, 8: 62–63, March 1912.

Passed, with some amendments by the General assembly, and vetoed by the governor. WARD, J. La Bruce. Hookworm disease; its eradication in South Carolina. South Carolina medical association. Journal, 7: 341-43, September 1911.

Work in the schools of 11 counties in South Carolina, chiefly the southern and southeastern parts; of the 1,100 children examined, 37per cent were infected.

That is, they gave clinical evidence of the disease. A microscopical examination would show a much heavier infection. Following that we examined about 4,500 children in Kershaw, York, and Abbeville. The lightest infection was in Abbeville County. We believe the adjoining counties will have as light an infection. Dr. Weinbery examined 1,180 children, and found only 7 suspects; whereas in some other parts of the State we found at least 75 per cent of the children showing clinical evidence; ... and I am satisfied, from the microscopical findings so far ... would have shown an infection of 100 per cent. . . . At Furman university, where 100 specimens were examined, without examining the men at all until after ... 38 per cent were found infected; . . . and I should not have made a single diagnosis on clinical findings.

"At Clemson College we found 33 per cent of 65 men examined infected, and I would not have made a clinical diagnosis of any of those cases.

“Taking the 9,000 children examined in the State, we find an infection of over 25 per cent, clinically; ... microscopical findings would have run much higher.”

TENNESSEE. HILL, David Spence. The status of school hygiene in Tennessee. In American

school hygiene association. Proceedings, 1911. Springfield (Mass.) 1911. p. 155-63.

There is little teaching of school hygiene in its technical aspects in Tennessee. The State has no general law requiring medical inspection of school children. In Knoxville, Memphis, Chattanooga, and Nashville encouraging beginnings have been made, but “no full-fledged system with sufficient nurses, trained physicians and thorough organization supported by the city or State exists in Tennessee.” During 1909-10 examination of throat and teeth was undertaken in Nashville. The following summary was presented by the inspector, Dr. E. L. Roberts, on December 26, 1910: Pupils examined.

2, 455 Detective vision.

143 Crossed eyes.. Trachoma

117 Other eye inflammations. Discharge from ear. Frequent earache.

123 Enlarged tonsils.

199 Defective teeth..

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698

TEXAS.

Fort Worth. (Superintendent of schools] Report of the medical supervisor. In his Annual report, September 1910. p. 35–47.

“Physical examination of school children was begun April 1. In all, over 1,000 children were examined, of these 710 were referred for treatment-medical, surgical, or dental. (It was not possible to examine systematically each child so near end of school year.)"

The first to fourth grades inclusive in all schools were inspected, and in most of the districts all grades.
The 710 cases referred may be summarized as follows:
Eyes...
Tonsils
Adenoids.
Ears...
Enlarged glands of the neck
Anemia..
Tuberculosis.

209 300 132

77 123 72 12

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8 10 25

Teeth.

203 Speech..

15 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. p. 59–60.

Signed: W. Wallace 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.

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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 educa tion 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 (healthful 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 infections.

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; ularged tonsils, 237; adenoids, 111; defective hearing, 13.

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, 20,684.

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, September 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.

Spokane. (Board of education] Medical inspection. In its Biennial report; for the two years ending June 30, 1910. p. 37–39.

Department of medical inspection organized at opening of school year 1909-10; chief inspector and four assistants. Regular inspection began September 1909. All schools shall be inspected at lcast 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 contagion 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.

“Replies received from nine cities showing that medical inspection to a greater or less extent was utilized in Seattle, Spokane, Tacoma, Everett, North Yakima, Olympia, and Aberdeen; negative replies were received from Walla Walla and Wenatchee, and no reply from Vancouver and Bellingham. ...

“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) Prevention of infectious and contagious diseases. (2) Scientific supervision of sanitary condition of premiscs, school buildings, 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, organized games, etc. (5) Physiology and psychology of ordinary educational methods, including fatigue, neurasthenia, hysteria, questions of sex, etc. (6) Special educational methods for abnorinal 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 about 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 examination blank, on which she records all the family and school history of the child she can collect. When found 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 deaf and dumb segregated into a school. No provision has been made for the weak, the anemic, or the crippled.

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 examine 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.

Cases.

Cases. Defective vision 340 Defective teeth

604 Disease of the eye 41 Skin disease

17 Defective hearing 99 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, (b) the necessity for temporary absence from school, (c) 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 permissible 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, after 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 Impetigo contagiosa....

.do.... 30 Molluscum contagiosa..

21 Infectious dermatitis.

do. 30 Pediculosis of any part of the body.

do. Ringworm of the scalp ( T'inea tonsurans).

months.. Favus..

year.. 1 Scabies of any part of the body.

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

.do..

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