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DISTRICT OF COLUMBIA.

MACATEE, H. C. School laggards. Some comments on the local situation.
Washington medical annals, 10: 149–59, June 1911. tables (from Ayres, L. P.)

Reprinted.
Conclusions:

"1. The public schools here exhibit the same problems of retardation and elimination as do those of other cities.

“2. The schools here are no better adapted to the average child with the average health history than are those in other cities.

"3. Educators should modify the school course so as to allow for the factor of illness; physicians should endeavor to restore children to the schools as soon as possible so as to avoid elimination from age and grade disparity.

“4. Special schools have been established here for the care of incorrigible and mentally defective children; other special ungraded schools ought to be established to care for normal children during temporary retardation, in order that they may be restored to their grades, and for physically defective children so as to adapt the schooling to the capacity of each child. Such schools should perform the same relative function in the schools as the convalescent hospital is designed to subserve in the care of the sick.

“5. The problems of retardation carry new things for the physician engaged in work among children to know.

“6. Adequate medical inspection is essential to the reduction of retardation in healthy children and in physically defective ones.

“7. Medical inspection as now provided is inadequate.
“8. School nurses are indispensable for the best results of medical inspection.

"9. Congress is not willing to give to this city what is everywhere recognized as an essential weapon against retardation of school children, having at the last session reduced the medical inspection service and having failed to provide for school nurses.

“10. The Dillingham bill providing for the establishment and maintenance of a laboratory for the study of defectives in the District of Columbia should be enacted, both for its broad general purposes arad also for the proper study and classification of defective school children.

"11. Retardation is in part brought about by repeated failures to succeed and thus may be a causative factor in the neurasthenias and psychasthenias so frequent in American life. The problem should engage the attention of physicians."

FLORIDA.

BYRD, Hiram. Medical inspection of schools. In Florida. State board of health.

Annual report, 1911. Deland, Florida, The E. O. Painter printing co., 1912. p. 331-41. (State board of health of Florida. Publication 96, June 1912)

Largely, the extent of hookworm disease in Florida and the need for medical inspection as a factor in its eradication.

“Let us pause here long enough to see if we can get the full import of this one disease.
“White people suffer from it more than negroes.
"Children suffer from it more than adults.
“The rural population suffers from it more than the urban.

"Our inquiry will be then to determine the cost in dollars and cents that hookworm disease entails upon our rural white children.

"Fifty-five per cent of our people are white. Seventy per cent of our people live in the country. Therefore 28 per cent of our white school children live in the country.

"A canvass was made by the State board of health covering 6,000 rural school children and it was found that 52 per cent of them were hookworm sufferers.

“From which it is seen that 15 per cent of the total school children of the State are suffering from hookworms.

“The extent to which the sufferer's vitality is lowered varies. But it can be measured with a fair degree of accuracy by the color of the blood. That is to say, rich, healthy, deep red blood is indexed at 100. The hookworm sufferer's blood becomes pale and watery in proportion to his infection. And as the infection gets worse and worse the color index of the blood runs down and down, 90, 80, 60, and even to 20 per cent of the normal. Perhaps an average color would be 70 per cent. But, to be especially conservative, we will assume that it is not so low as that. We will assume that it is 80 per cent. That means that the sufferer is off 20 per cent in strength, 20 per cent in intellectual energy, 20 per cent in power of learning.

“Now if 15 per cent of our school children are off 20 per cent in power of development, that lowers the whole power of development of the school children of the State by 3 per cent.

“We expend upon our public education now about $2,000,000 a year. Three per cent of $2,000,000 is $60,000.

“Are these figures facts? Verify them for yourselves. Sixty thousand dollars of our all too scant educational fund wasted annually-literally devoted to the maintenance of hookworms. Sixty thousand dollars for hookworms, and we haven't taken into account any of the negro population. Sixty thousand dollars' loss, and we haven't taken into account any children under or over school age. Sixty

thousand dollars' loss annually.” Florida. Committee on sanitation and public health for the schools of

Florida. Report and recommendations. In Florida. State board of health. Annual report, 1911. Deland, Florida, The E. 0. Painter printing co., 1912, p. 325-27.

Chairman, Hiram Byrd.
Recommendations:

"(@) That 'Medical inspection of schools' be defined as a systematic effort to proter: improve the health of any or all pupils. With this in mind we would recommend

(6) That the time is ripe for the medical inspection of schools. "(c) That the individual school, whether large or small, must of necessity be the unit of operation.

“(d) That medical inspection may be as complete or as partial as the individual school desires or can afford.

(e) That it may be carried out either by the board of education or the board of health. (This refers strictly to the local board of education and local board of health.)

"(1) That it may be undertaken by any school in the State, however large, or however small. "(g) That the larger schools can make it more thorough and complete than the smaller one; but

"(h) That no school is too small to introduce some definite systematic regére looking to seme form of protection of the health of the pupils.

“NOTE.--In many schools, particularly in the rural districts, the most important public health problem is hookworm eradication. This can be accomplished by the teacher, pupils, and parents, without any further advice than they can get from the State board of health.

(i) That where it can be afforded medical inspection should be carried out by the combined efforts of the teacher, the doctor, and the nurse.

"(j) That where all three can not be afforded, by the teacher and doctor without the nurse. (k) That where a doctor can not be had, it can be carried on by the teacher.

"NOTE.-There is a considerable amount of work that the teacher can do without the assistance of a doctor. In Massachusetts the teachers examine the eyes of the pupils, not to determine what ails them, but to determine whether they are normal or abnormal. If any marked deviation from the normal is found, the pupil is referred to a physician.

(1) This presupposes a certain amount of definite information of a more or less technical character, that in the ordinary course of events the teacher does not get, to which end we believe that the teachers should receive definite instructions as to how to conduct such examinations as may be deemed advisable.

(m) That the meeting of the teachers in the several county institutes, and at the State teachers association, and the summer normals, and the colleges, atford convenient fora from which the necessary instructions can be given.

"(n) That the State board of health is the logical body to undertake the instruction of the teachers for this work, hence we believe

(0) That the immediate need is for the State superintendent of public instruction, and the State health officer, to cooperate in providing for a course of demonstrations in all the summer normals and similarly in all the colleges which have normal departments, and

"(p) That these demonstrations shall cover such features as may be adjudged of vital importance by the State health officer and the State superintendent of public instruction.” STILES, Charles Wardell. Frequency of hookworm disease or ground itch ane

mia among public school children in Southern Florida. Public health reports, 25: 351-54, March 25, 1910.

"Summary of 1,306 pupils in 8 schools in 6 towns in 3 counties.

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“These statistics of school children are exceedingly significant, from various points of view:

“First. These children are growing up under a severe physical handicap. If they do not undergo medical treatment, not only will this handicap be appreciable in deaths due directly to hookworm infection, but this infection will so reduce their vitality that they will more readily fall a prey to other diseases, such as tuberculosis, pneumonia, malaria, etc.

“Second. Their physical development is of necessity inhibited, and many of them may reach maturity stunted in their growth.

“Third. Children in this condition can not possibly be expected fully to assimilate the education which is being given to them, and as a result the money being spent on education is not giving to these towns fuil returns. ...

"Fourth. Not only these three counties but all other parts of the South visited by winter tourists should awaken promptly to the self-evident fact that the danger is present that such tourists will soon avoid those rural portions of the South in which the soil pollution is so extensive as to lead to 55.9 per cent hookworm infection among the school children. .

“At least five of the teachers in the schools visited showed clear and pronounced effects of hookworm infection."

GEORGIA. Atlanta. Board of education. Department of medical inspection. In its Report, January 1912. p. 231-32.

Signed: Robert G. Stephens, M, D.

Medical inspection established in Atlanta, winter of 1909. Force, to date, consists of chief examiner, one white assistant, one colored, four white nurses and one colored.

“Method pursued is that of routine examination. A school is visited daily by an examiner and nurse until each child in that school has received a physical examination." Defects are noted on individual cards. "If the defect is remediable a notice card is sent to the parents suggesting that dental or medical attention be given. . .

“Out of 5,838 recommended for treatment in 1910–1911, 50.9 per cent received treatment, but in order to get this number treated the nurses made 4,814 visits to homes.

"Schools examined for the first time furnish in every instance from 60 to 94 per cent of the children defective." Augusta and Richmond County, Georgia. (Board of education] Medical inspection of schools. In its Annual report, 1910. p. 22-23; 111.

“During the past year we have had a very satisfactory experiment with ... district nurse visitation and inspection at the Jobn Milledge school. The district nurse of the fifth ward has attended that school for two or three hours each week, has visited all the grades, and has had referred to her all suspected cases of disorder or disease. She then refers the cases to the regular physician of the city, or to specialists. ...

“There is also a movement on the part of the board (of education) to engage the cooperation of the board of health by which ... at least one nurse and one physician shall be especially set apart for school inspection ... as a part of the regular work of the board of health by which a complete system

of medical inspection can be inaugurated for all the schools." FORT, A. G. Examination of county school children. Medical association of Georgia. Journal, 2: 7, May 1912. table.

“The combined results of the inspection of three rural counties in Georgia are as follows:

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Anemia...
Defective vision.
Defective teeth.
Enlarged tonsils.
Adenoids
Defective heart sounds.
Sounds indicative of pathological conditions in lungs.
Diseases of ears.....

894 292 596 406 400 77 33 110

774

Number examined..

28 368 252 144 20 72 2

1,668

320 964 658 544

97 105 112

1,603

1,556

3,219

"In the inspection of the sanitary surroundings of 59 of these schools, we found 17 privies only, and all of these poorly constructed. Is it any wonder then that 1,668 gave clinical evidence of hookworm infection and microscopical examination revealed that an average of 74.7 per cent of the suspects were

infected?" FORT, A. G. (Hookworm disease among Georgia school children] American

school board journal, 43: 39, October 1911.

Defectives among the children of Stewart, Webster and Tift counties, Georgia.

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Savannah and County of Chatham. (Board of education) Health and sanitation. In its Annual report, year ending June 30th, 1910. p. 16–18.

“Whenever in the judgment of the principal a pupil of the public schools needs medical treatment ... he shall notify the parent or guardian. ... Such pupil shall not be permitted to continue in attendance upon the public schools until a certificate from the attending physician shall have been presented to the principal.”

This plan bas been in operation since January 1, 1910. Cases reported, 191. (Stephens, Robert G.) Medical inspection of school children. In Georgia educa

tional association. Proceedings and addresses, 1911. Atlanta, Ga., Bennett printing house. p. 65–73.

General résumé, by the medical examiner of schools, Atlanta, Ga.

"Out of a group of 2,375 examined in Atlanta in 1909, 1,452 were defective, or 61.1 per cent; out of 2,166 in Atlanta examined in fall of 1910, 1,653 or 76.2 per cent were defective.”

Defects: Atlanta, 1910. Nutrition...

50 Anaemia Glands

192 Heart. Skin. Nervous.. Teeth.

1,372 Tonsils. Adenoids. Eyes.. Lungs.

Two medical inspectors and four nurses work under control of board of education. Two allowed to elapse following notification to parents of defects, after which time a nurse visits the home of each defective child who has not returned a card signed by physician or dentist.

28

11 42 6

375 257 189

9

are

IDAHO.

HYDE, George E. Medical inspection of schools. Northwest medicine, n. 8. 3:

340-43, December 1911. Rule V, of the State board of health of Idaho, requires the county physician to “report, on or about September 1 of each year, the sanitary condition of the public schools of the county in which he resides."

The author receiving permission to examine the school children in his home town, Rexburg, “to see if the findings of inspection in other parts of the county could be bourne out" by his personal investigation. Teachers tested the eyes with Snellen's chart, took records of heights and weights, ages, grades, number of years attending school, and history of contagious diseases; Dr. Hyde examining the ears, nose, throat, and teeth.

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Deafness.
Adenoids.
Hypertrophied tonsils.
Müd eye defect:

Ranging from 20/30 to 20/40.
Ranging 20/50 to 6/200.

(31 of these pupils had headaches on reading; 12 had change of posture at

desk in order to be able to write their lessons; 11 could not see the lesson

written on the blackboard, from where they sat in their room.)
Defective teeth (of these, 25 per cent in very bad condition)..
Mitral regurgitation (histories of rheumatism in 4 cases)....
No discoverable defects in.

55

5

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*These results ... show that the children in this western country have not nearly the same number of physical defects among them as examination shows exists among the schools of the East."

ILLINOIS.

Chicago. Board of education. Department of child-study and educational

research. Child-study and educational research. In its Report of the Superintendent of schools for the year ending June 30, 1912. p. 44-50. table.

From Report of directors, D. P. MacMillan.

“Of the whole number of children, 2,095, examined during the year ... with the exception of truants and incorrigibles ... the maximum number, 469, falls in that group which is made up of children with nervous disorders, particular physical defects or general constitutional depletion. In the majority of cases they proved to be extremely backward pupils."

34 466

12

Children examined from July 1, 1911, to June 30, 1912. Blind or defective vision.

115 Deaf or defective hearing.

125 Crippled....

58 Truants and incorrigibles, at office, Truants and incorrigibles, parental school Subnormals.

259 Defective in speech (persistent cases only).

66 Tuberculous (not including anaemics). Epileptics (most aggravated cases only).

13 Children with constitutional depletion or nervous disorders or specific physical defects.

469 Special cases: Unusually bright children, moral delinquents, mental aberrants..

276 Chicago. Department of health. Bureau of contagious diseases. Medical school inspection. In its Report, 1907–1910. p. 22–33, 39. tables. chart. forms.

" For the supervision of approximately 400,000 school pupils in the public and parochial schools ... the city employs 100 medical health officers and 41 nurses, all of whom secure their appointments by competitive civil service examinations. For administrative purposes 5 medical health officers are selected to supervise without extra pay, the other 95; and 2 nurses, one receiving $15 per month more than the others, supervise the other 39. The city is divided into 95 districts, to each of which is assigned a medical health officer, whose duty it is to inspect the pupils in the schools of the district. In addition, he has control and supervision of all contagious diseases in the territory to which he is assigned. .

“The medical health officer makes daily visits to each school assigned him, commencing work at 9 a, m, At the beginning of the term he makes a rapid inspection of all pupils to determine if any bear evidence of a contagious disease.

“For this preliminary inspection the health officer visits each room, stands with his back to a window, and has all pupils in the room file past him. ... The pupil . . . exposes to view palms of hands and wrists; with the fingers of one hand pulls down the eyelid, exposing the conjunctiva; opens the mouth and puts out the tongue. This hurried inspection is made by the physician without touching the pupil. . .. After the completion of this preliminary inspection ... the regular forenoon inspection is taken up.

“Inspections and examinations at high schools are done only on request or ... emergency. Parochial schools desiring ... have the same service as the public schools. Inspection for contagious disease in parochial schools is enforced. In making physical examinations, we begin with the pupils in highest grade, completing one school before beginning physicals' in another.

"The daily routine is as follows:

“Inspection is first made for contagious diseases, after which ten or more physical examinations are made.

“The health officers request principals to have all pupils in readiness for inspection who have been absent four consecutive days ...

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