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CITY OF PHILADELPHIA.

Results obtained by a medical inspector when not aided by a nurse.

[Number of individual children reported upon, 751.)

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Results obtained during the same period by the same medical inspector when aided by a

school nurse.

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Results obtained by medical inspector not aided by a nurse.

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9

10,969

3,096
1,928

3, 139 2,007

Schools...

39 Nurses. Old cases..

42,869 New cases

16,341
Cases cured
Visits to schools.

5, 108
Visits to home (old).
Visits to home (new)..
Total number of visits to homes.

5,024
Visits to dispensary (old).
Visits to dispensary (new)..
Total visits to dispensary.

5, 146 School consultations (parents)..

754 School consultations (pupils).

2,687 Total school consultations..

3, 441 Examinations for uncleanliness.

30, 099 Examinations for bureau of municipal research.

737 NEWMAYER, s. W. A practical system of medical inspection with trained

nurses, adapted for public schools of large cities. New York medical journal, 87: 637-39, April 4, 1908. forms.

Reprinted.

Discusses the medical inspection system devised by Dr. Newmayer for use in Philadelphia schools. The chief factors considered were:

"1. The elimination of useless clerical work.

“2. Methods which would secure cooperation between medical inspector, nurse, principal and teacher, and parents.

“3. The unnecessary exclusion of pupils, and, when excluded, their return in the shortest possible time.

"4. Each party concerned assumes his or her share of the responsibilities, and errors can easily be traced to their source.

“5. Records and reports are few and can readily be referred to for practical purposes." Philadelphia. Superintendent of public schools. School nurses. In his Annual report, year ending December 31, 1910. p. 44-45. table.

“The nurse teaches both the pupils and the parents the value of practical hygiene and accomplishes results. She thus becomes . . . an invaluable adjunct to medical inspection.”

Record of results in schools where nurses are employed as compared with schools without nurses.
A comparative study by the Department of health and charities.

SCHOOLS HAVING NURSES.

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13

ST. LOUIS, MO.
St. Louis. Board of education. Department of school hygiene. In its
Annual report, year ending June 30, 1911.

p.

141-48. At the beginning of the year, a corps of six nurses was added to the Department. Duties and lines along which their work was carried on:

“1. To assist inspector of hygiene in his examinations and to carry out his instructions.

2. To keep records of children examined, making special notes as to what treatment has been obtained.

“3. To examine all absentees returning to school before they enter rooms, with a view of detecting evidence of infectious or contagious diseases, excluding or holding children in suitable quarters for further examination by inspector of hygiene.

“4. To visit homes of all excluded children or children whose parents do not respond to repeated notices from the inspector of hygiene of the existence of some physical defects, which materially impedes the child's progress in school.

“5. To interview and advise parents, getting information of the social and hygienic conditions of the home of pupils incorrigible or morally weak, suggesting proper clothing, food and cleanliness.

“6. Advising parents or guardians of the need of certain medical or surgical treatment, also advising them where the free medical and dental clinics are, also where the free childrens hospitals are located.

7. When the time will permit, they can make eyo and ear tests of children selected by the inspeo tor of hygiene.

“8. To be responsible for the personal hygiene and cleanliness of all children under their care.

“9. To observe the matter of ventilation, light, heat, and proper seating of children, and bring to the attention of the principal and supervisor of hygiene.

“10. To assist in caring for children who are in need of emergency medical or surgical treatment while in school, having an emergency chest at her disposal.

11. To assist principals, teachers and inspectors in determining the matter of unfitness or fatigue among the school children, especially in the matter of physical training.

12. Their visits to the homes of excluded and sick, absent children will be the direct means of having them returned to school at the very earliest possible moment."

Nurse record blanks, p. 143–46. Other blanks, p. 147, 149.

Summary of district nurses' reports.
Visits to homes of pupils...
Visits to hospitals.
Visits to clinics.
Operations secured through visits.
Fitted with glasses through visits.
Emergency attentions at school.
Dental treatments..

1,560

55 934 253

191 1,003

196

TRAINING OF MEDICAL INSPECTORS, SCHOOL NURSES,

AND SCHOOL TEACHERS.

American academy of medicine. Report of Committee for teaching preventive

medicine in universities and normal schools. Its Bulletin, 13: 20–22, February
1912.

Chairman, Henry B. Hemenway.
A preliminary report.

“Preventive medicine is not taught in a thorough manner by most medical schools. Very few hours are devoted to this branch in the advised curriculum. ...

Secondly, there are few competent to take positions as professors of public health in universities. ... At the University of Wisconsin, under . . . Prof. Ravenel, a course in public health has been inaugurated. Columbia and Cornell universities and the Massachusetts institute of technology are doing the same. Judging from results, the Massachusetts Institute of technology is today giving better instruo

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Hon in this lino than any medical school in America.” The Harris lecturer at the Northwestern uni.
versity for 1912 will be Dr. Milton J. Rosenau.

Discussion: p. 22–26.
BURNETT, James. The teaching of school hygiene. Medical record, 79: 711–12,
April 22, 1911.

Courses of instruction before a candidate for diploma in school hygiene is admitted to examination, in:
"1. Practical instruction in children's diseases (three months). 2. Examination of the eye, ear, nose,
and throat (three months). 3. School hygiene, as outlined above (six months), the course to include
practical examination of school children under a specially recognized teacher.

The diploma would require but a year's additional special training. “If such a diploma were insti tuted, and satisfactory instruction given in school hygiene, the standard of the school physician would

be raised." DITMAN, Norman Edward. Education and its economic value in the field of

preventive medicine. The need for a School of sanitary science and public health. Columbia university quarterly, 10, June 1908, supplement. 70 p. diagrs, map. tables. (Appendix I, II)

Bibliography: p. 69–70. Reprinted.

A school of preventive medicine should be planned to give instruction to the following groups: 1. Students preparing for the practice of medicine. 2. Students preparing for offices of health boards and sanitary inspectors. 3. Students preparing for sanitary engineering-civil, military and naval. 4. Students preparing for work as school and college teachers, school nurses and school inspectors. 5. Students preparing for work as officers of charity societies and institutions, visiting nurses and "social workers." 6. Students preparing for the ministry. 7. Students preparing for the work of legislators. 8. The public.

Subjects of instruction proposed for school nurses and school teachers. Conditions concerned in the cansation and occurrences of disease in individuals, groups of individuals, and communities.

+ Modes of transmission, portals of infection, geographical and seasonal distribution of transmittablo and epidemic diseases, and the approved methods of prevention of these and other diseases.

+ Legal aspects of methods of isolation, quarantine, medical and sanitary inspection, compulsory
vaccination and inoculation, school attendance, notification, and of methods for proventing the trans-
mission of communicable and epidemic diseases.
+The liquor problem; insanity, pauperism and crime dependent on disease and intemperance.

+ American social conditions (including immigration, the growth and concentration of population in cities, with the attendant dangers).

+ Sanitary legislation and organization.
Principles of relief; organized charities.
Social and moral prophylaxis.
+ Diseases of animals transmittable to man; relation of insects to disease.

+ Hygiene of the child and the adult, the school and the tenement house, hygieno of ventilating,
heating, atmospheric pollutions, and their influence on health and disease.
+ Theory and practice of physical education.
*Correction of conditions which interfere with the physical welfare of school children.
+ Social and vital statistics.

+ Adulterated and unwholesome food; markets, bakeries, hotels, restaurants, infected food, ice, cannod goods and watør supplies.

+ Dairy products; milk, etc.; inspection of herds and dairies; use of tuberculin test, pasteurization, milk analysis and laws.

*Dangerous occupations and preventable accidents.
+ Excursions for sick children, fresh air funds, visiting nursing, oto.
+ Sanitary museum exhibits (see Park's Museum catalogue).

Compiler's note: Cross mark (+) indicates subjects included in training of school inspectors; to which author adds: Medical and sanitary inspection.

Subjects marked with a star (*) may be omitted in training of school teachers; to which training tho suthor adds:

Municipal, State, and National Government.

Municiapl sanitation: (1) Pollution of water and ice supplies, methods of purification and relation to health and disease. (2) Construction of reservoirs, filtration plants, sewage and water systems; methods of sewage and refuse disposal; street cleaning. (3) Public baths, parks, and comfort stations. (4) Public

nnisancos, offensive trades, smoke, stables, noises and filth. FORCE, John Nivison. Standardization of the health and development require

ment. California. State board of health. Monthly bulletin, 5: 190–91, February 1910.

Medical inspectors in California.

"At the last session of the legislature a bill was passed authorizing school boards 'to establish health and development supervision in the public schools of this state. The law further provides that the examining staff for health and development supervision shall consist of persons holding a life diploma of the high school or grammar grade, and persons holding a certificate to practice medicine and surgery.

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In addition persons so qualified must have a health and development certificate issued by county boards of education on presentation of a 'recommendation from the State board of education certifying special fitness for the work. The law provides no standard of requirement by which the State board of education shall act in determining 'special fitness,' and the suggestion has been made that in choose ing the medical members of the staff, the endorsement of the candidato by his county medical association be secured by the State board of education. This is a most excellent idea as an additional saloguard with regard to medical fitness, but takes no account of the 'special fitness' desirable in dealing with problems of the public health. The following is an attempt to suggest a plan of procedure which will serve to standardize this requirement.

“Recommendations from the State board of education certifying special itness for health and development supervision in the public schools of this state will be granted only to:

“(a) Persons certified by the University of California or other institution of like standing as having completed a course in hygiene covering the following subjects:

“1. Sanitary engineering. Elementary knowledge of the construction and sanitation of water supplies, the disposal of sewage and sewerage systems, and the disposal of refuse.

“2. Sanitary architecture. The plumbing, lighting, heating, and ventilation of buildings.

“3. Food inspection. The sanitation of the meat, milk, vegetable, and grocery supply and the detection of adulterants.

4. Personal hygiene. The essentials of personal hygiene including anthropometry and the prescrip tion of exercise.

“5. Vital statistics. The application of statistical methods to the conservation of the public health. “6. Epidemiology. The hygiene of transmissible diseases.

7. Sanitary law. The health laws of the State, the school laws of the State, and the Federal laws designed to conserve the public health.

"(0) Persons otherwise qualified, passing an examination in the above mentioned topics to be given by the State board of health.

“The examination mentioned in section (b) could be given either by the State board of education, by the State board of health, by the State board of medical examiners, or by the State board of exam

iners for registration of nurses appointed by the regents of the university.” FECHE, Arthur. A report on the teaching and practice of hygiene in the public

normal schools of the United States. Journal of educational psychology, 2: 429–39, October 1911. tables.

Questionnaire sent to 191 of the 203 most important normal schools listed in v. 1 of the Bureau of education report for 1909, elicited returns from 84. “Eractly one-half of the 84 heard from offer no hygiene courses aside from the hygiene given with physiology or incidentally in courses on school management, methods of classes, psychology, etc." Nine schools give neither physiology nor hygiene, and only one school

attempts to train special teachers of hygiene. HILL, David Spence. The cooperation of educational and of medical departments

of American universities. In American school hygiene association. Proceedings, 1912. Springfield (Mass.) American physical education review, 1912. p. 136–51. tables.

Also in Science, 1. 8. 36: 647–59, November 15, 1912. Title: The need of practical cooperation of educar tional and of medical departments in modern universities.

Reprinted.
Questionnaire sent to medical colleges and departments embraces the following questions:

I. (a) What courses intended specifically for teachers or prospective teachers are being offered by your medical department? (6) Duration of courses? (c) Number enrolled this year? (d) Any certificate or diploma awarded for completion of same by teachers or prospective teachers?

“II. (a) What courses in pedagogy are offered by your department of pedagogy or education for the benefit of physicians or medical students or nurses who are or intend to become inspectors of schools (6) Duration of courses? (c) Number enrolled this year? (d) Any certificate or diploma awarded for completion of same by physicians, medical students or nurses?

"III. Please write any other relevant information or practical suggestion regarding possible need for cooperation between medical and pedagogical departments.”

Of the 112 inquiries sent to the medical colleges, 69 responses were received; of the 100 sent to departments and schools of education, 105 responses were received.

Most of the responses from medical colleges indicate: “No work whatever for the benefit of prospective teachers"; from educational departments, "no work especially intended for medical inspectors, school nurses or school sanitarians"; from medical and from educational departments of certain universities, "no active affiliation reported.” Scarcely half a dozen universities report a reasonably effective scheme for cooperation of medical and educational departments. The cooperation of trained workers in the medico-pedagogical field has gained headway against difficulties.

“1. With reference to the need of the schools, provisions should be made for senior medical students, and especially for graduates, in the educational department for instruction and training in the essentials of pedagogy. ... In basal study of psychology of common interest to teacher and physician, the

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