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“All children to be examined are sent to a room by themselves. ... Inspection is made with reser, ence to communicable diseases and vaccinal status of pupils.

“Pupils with marked defects needing immediate attention ... referred by the principal, teacher or nurse, are examined without delay. If agreeable to the principal, Friday is (the) . . . day for such emergency examinations.

“Health officers are forbidden to make any suggestions as to the treatment or management of pupils who are sick. This command is imperative.

"Beginning November 1, each year, medical officers vaccinate free of charge any child or pupil who may apply to them for vaccination: .. vaccinate no child without the consent of parent or guardian.

- Health officers carry with them the following supplies Circulars on Prevention of consumption; The vaccination creed: special circulars on each of the infectious diseases, and warning slips to dis. tribute and post in public places; wood spatulas for tongue depressors (Each tongue depressor is used only once and then burned); culture media and outfits for Widal test."

The blanks follow in the order in which they are used: Family history; physical record; medical inspection of schools exclusion; non-exclusion notification of abnormal condition; health officer's daily report; card for child to take to physician and return to school nurse; health officer's monthly report.

A summary of the reports of the school medical inspectors of the Department of Health, of Chicago. for the year 1909, gives the following statistics:

of the total number of children examined, 123,897 (51 per cent) were defective.

Defects.

Per cent of
the total
defects.

Defects.

Per cent of the total defects.

1.8
1.0

Teeth defects..
Tonsils hypertrophied.
Vision defective...
Glandular enlargement
Nasal affections
Adenoids.
Anemia.
Nutrition imperfect.
Hearing defective.

32.3
20.0
15.9
12.3
4.8
3.0
2.6
2.2
2.0

Skin diseases.
Orthopedic defects.
Heart diseases..
Mentality defective.
Nervous diseases.
Pulmonary diseases.
Palate defects..
All other defects..

.5
4

East St. Louis. Board of education. Retardation. In its Annual report, 1910–11. p. 34-46. tables (Grades 1-12)

“Of 534 puplis marked to repeat the work of next term,” 48 suffered from physical defects; 44, menta! defects.

In all white schools, pupils, 6,842; over age, 676, or 39 per cent. In all colored schools, pupils, 1,082; over age, 714, or 69 per cent. HEDGER, Caroline. Physical examination of below-grade childrer. Mlinois medical journal, 15: 433-39, April 1909. tables.

Examination of 208 (125 boys; 83 girls) below-grade public school children in Chicago.

Boys.

Girls.

Cervical glands....
Goitre..
Hypertrophied tonsil.
Irregular pulse.
Hemic murmurs.
Transmitted apical murmurs
Lateral curvature...
Negative lungs.
Suspicious lung findings.
Positive lung findings.
Cough...
Pediculosis.
Bad teeth.
Tea and coffee..

Percent. Per cent.

89.6 95.1 23. 2 25.3 55. 2 (5 23.2 19 50.4 36.1 11.2 10.8 20

39.7 41.6

43.3 10

43.3 18.4 13.4 8

19 40

72.3 25.6 25.2 99.1 100

87

Quincy. (Board of education] Medical inspection. In its Annual report of the

public schools, school year ending June 30, 1911. p. 31–38. tables. Total number inspected.

3,018 Defective.

1,191 With defective eyes.

284 With defective hearing. With throat defects.

770 With nasal defects..

336 With defective teeth.

292 With malnutrition. With nervous trouble. With kidney trouble....

23

Physicians assigned to the various schools, for the inspection, at a joint meeting of the committee of the Adams County medical society and the board of education.

Signed by Committee of board of education, and Superintendent of city schools Edward G. Bauman.

KENTUCKY.

HANCOCK, D. 0. School sanitation. Kentucky medical journal, 9: 724–26, October 1, 1911.

Proposes a "Health committee for each school, composed of four members, the teacher, a physician, and a woman and a man who are each patrons of the school. ...

“That this committee have immediate charge of health matters in the school and district; that it be organized, president, secretary and medical inspector; that it have meetings once each month and oftener if needed; that it keep records of its doings; ... that this committee see to it that the schoolhouse is properly constructed and kept; that conditions are such as will insure the comfort and health of teachers and pupils; that contagious diseases are immediately controlled; that infectious diseases are not carried to the school.

“There is a useless and criminal sacrifice of time, comfort, health and life in our schools which should not exist. . . . The remedy is immediate supervision by those who are on the field and who have personal interest at stake."

Following this address of Dr. Hancock before the Henderson county teachers' Institute, August 24, 1911, a resolution was adopted:

" Resolved, That the county superintendent of schools is hereby requested by the institute to appoint a health committee as suggested by the paper of Dr. Hancock, in each school district in Henderson County; that the teacher and trustee of each school are hereby requested to organize the committee thus appointed and to assist it in doing the work contemplated; that the county superintendent have printed a list of these committees for use in organizing for school sanitation."

LOUISIANA.

New Orleans. Superintendent of schools. (Report of the] Department of hygiene. In his Annual report, 1910-1911. p. 85-142. tables.

Reported as defective by grammar and primary grade teachers, 2,339 pupils; and 85 kindergarten pupils.

Boys.

Girls.

Total examined, 1,303:

Defective hearing...
Enlarged glands..
Defective vision.
Defective breathing.
Defective teeth.
Hypertrophied tonsils
Adenoids..
Other defects..

22
454
193
158
499
161
77
96

20 323 280

91 360 151 50 50

From September 26 to June 16, the total was: Scarletina.

231 Diphtheria.

145 Measles.

660 Smallpox...

12 Among nonquarantinable exclusions were: Impetigo..

57 Scabies..

215 Pediculosis.

197 Eczema (chronic)....

27 Applicants for teachers' positions and pupils entering normal school required to stand a physical examination.

MAINE.

Augusta, Maine. Board of education. Medical inspection. In its Annual report, 1910–11. p. 29–33. tables.

"Organization of this department is as follows: First, the employment of two physicians. . . . Second, an annual ear and eye test, conducted by the teachers. . . . Third, an annual inspection of the teeth by the dental inspector. Fourth, the distribution of the health leaflets issued by the State board of health. ...

“Medical inspectors shall visit and inspect monthly each building assigned to them; shall examine any teacher or school employee whenever such examination is necessary; . . . shall visit each schoolroom at least once a year and make a general examination of the pupils; . shall examine all pupils referred by the board, the superintendent, principals, or teachers; . . . and shall exclude from school any employee or pupil whose presence is dangerous to the health of the school. They shall furnish teachers such information and instruction as they may deem necessary in the interest of health. They shall report to the superintendent any insanitary condition in or around school buildings. . . . Medical inspectors, and school employees acting as such, shall give no treatment."

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Table IV.--Showing results of dental inspection in the schools.

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Number examined...

60 Number who

received dental attention..

16 Number of cases

teeth need cleaning..... 50 Number of cases

decayed teeth... 46 Per cent having

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defective teeth.. 76. 7 Per cent who had

received dental attention.... 26.6

87.2

94.0

68.392.3

76.5

73.9

61.8

63.5

50.0 61.7

91.1

77.3

10.9

22.2

15.0

22.3 28.7

33.9

45.4

62.5

70.6 70.4

16.0

31.0

Maine. State superintendent of public schools. Medical inspection. In his
Report, 1910. Augusta, Kennebec journal print, 1910. p. 105–14. map.

Map showing States having medical inspection, p. 114.
Law in effect, in Maine, July 1, 1909.

MASSACHUSETTS.

HANSON, Justice G. Medical inspection in public schools. Boston medical and surgical journal, 163:242-43, August 11, 1910.

"If careful systematic inspection is carried on throughout the State, succeeding generations because of it will be less burdened by physical and mental cripples, will be more free from contagious and infectious diseases, and will have a more intelligent conception of disease, and its cause and effect.”

Discussion: p. 243-45 (Dr. Thomas F. Harrington.)

MARTIN, George H. Medical inspection in the public schools of Massachusetts.

In Massachusetts. Board of education. Annual report, January 1911. Boston, Wright & Potter printing co., State printers, 1911. p. 164–193. tables.

Reprinted.

"All of the 33 cities and 297 of the 321 towns report in the annual school returns for 1909 that school physicians bave been appointed. ...

In other words, 98 per cent of the school pupils in cities and towns are having nominal medical inspection. ...

“From the returns received at the office of the board of education and the published reports of city boards of health, it appears that during the year 1909 there was spent for the medical inspection of school children the sum of $101,745.59. This is an average of about 20 cents per child. But as in some cities, where the inspection is in the hands of the board of health, the parochial schools are inspected as well as the public schools, and in Boston, which has about one-fifth of all the enrolled children in the State, the cost of inspection is much above 20 cents, the actual average cost outside of Boston is much below 20 cents.

"What school authorities should do is stated by the statutes . . . to be twofold:

“First, to provide for a general examination of all the children in the public schools at least once a year for any defect or disability tending to interfere with their school work.

“Second, a special examination of children (a) who show signs of being in ill health or of suffering from infectious or contagious disease; (b) who are returning to school after absence on account of illness or from unknown cause. ...

“There is another function of the school physician. ... The law says he shall make 'such further ex. amination of teachers, janitors and school buildings as in his opinion the protection of the health of the pupils may require.' ..

“Dental clinics for school children have been established in a number of localities.

"In Lynn a dental dispensary was carried on in 1910 in connection with a neighborhood house. Fifteen Lynn dentists and 10 out-of-town dentists gave their services. A nominal charge was made of 15 cents for cleaning, 10 cents for extraction and 25 cents for fillings. One thousand and ten operations were performed upon children. ...

"In Winchester ... the dentists in town, nine in number, each give one-half day a week to work with needy cases, at a nominal charge of 25 cents per case. . . . The school nurse works in cooperation with the dentists...

"The school returns show that the eye and ear tests have been given as required by law in all the towns and cities, excepting Otis and Mount Washington., Four annual examinations have been made since the law was passed. . .

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“One or more nurses are now employed in the schools of Amherst, Boston, Brocton, Brookline, Cambridge, Canton, Holyoke, Lancaster, Leominster, Lowell, Northampton, Northborough, Walpole, Wal.

tham and Winchester." SNEDDEN, David (Samuel] Problems of health supervision in Massachusetts.

In American school hygiene association. Proceedings, 1912. Springfield (Mass.)
American physical education review, 1912. p. 18-26.

Also in Journal of education, 75: 458-60, April 25, 1912.
“I. Legislative provisions.
II. Application of laws.

“III. Problems of health supervision: A. How can health supervision be planned and organized so as to promote effective administration? B. What should be the distribution of the functions of health supervision among various possible agencies, such as teachers, nurses, physicians, physical trainers, and the home? C. What must be the character and training of those cooperating in this work? D. What shall be their relation to the existing school authorities? E. What will be the necessary financial cost of such service? F. What shall be the control of health supervision over the actions of parents and other non-school agencies affecting the children; and G. Is there needed provision of facilities for investigation and supervision by state authorities?

BOSTON

AYER, S. H. Medical inspection of schools in Boston, Mans. Boston medical and surgical journal, 164: 456-60, March 30, 1911.

Historical sketch; salaries, etc., Boston and New York.

Read at the Boston health conference, 1915, February 20, 1911. COUES, William Pearce. The medical inspection of schools in Boston, the pres

ent limitations and future possibilities. Boston medical and surgical journal, 160: 746–48, June 10, 1909.

“The teachers in the various rooms send a slip down to some central place with the child's name, number of the room and symptoms of trouble. ... The inspector summons the children to be examined ... (and) examines them, writing on the slip the diagnosis and advice. He sees only the children whom the teacher sends slips for, that is, the primary necessity for medical inspection devolves on the judgment of the teacher.

“One of the conditions which should be changed ... so that the teacher can be freed from responsibility and care in this matter." COUES, William Pearce. Some problems of school inspection. Boston medical

and surgical journal, 164: 814–16, June 8, 1911.

Result of eramination of 158 retarded pupils.

Number. Per cent.

Defective vision
Defective hearing.
Chronic enlarged tonsils.
Defective or carious teeth.
Marked pallor..
Markedly undersized.
Extremely nervous..

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2 122 127 34 3 1

1.2 77.2 80.3 21.5 1.8 .63

"It is of interest to compare the result ... with that of : 212 children of normal mental caliber; 72 per cent of these children showed chronic enlarged tonsils; 50 per cent showed carious teeth. . . . It would seem from these statistics that chronically enlarged tonsils and the generally accompanying adenoids had little to do with the mental backwardness of these children, but that carious teeth might

play a considerable rôle in the causation of this condition.” GALLIVAN, William J. Child hygiene. Monthly bulletin of the Health department of the city of Boston, 1: 29–36, 50, February 1912. tables.

Division of child hygiene "was created in March, 1910. It is concerned with the physical welfare of every child in Boston from the time of conception up to the age of 16 years. The work is classified . . . as follows: 1. Pre-natal and post-natal work. 2. Medical inspection of schools. 3. Physical examination or licensed minors.

“Medical inspection of schools begins at the kindergarten class and ends with the high schools. Or equal importance are the three objects ... in view, as follows: 1. The detection of communicable diseases and the exclusion from school of every pupil so afflicted. 2. The protection of every pupil in the schools from contagion unrecognized hy parent or teacher. 3. The detection of such defects which if untreated would result in permanent injury to the pupil.

“The board of health is emphatic in its stand against prescribing for any discase or defect discovered. ... Every case requiring medical or dental aid is referred to the family physician or to the family dentist. Those who are unable to employ professional services are referred to reputable hospitals or dental clinics.

“ Under the present system, the school physicians are under the authority of the board of health; the school nurses are under the anthority of the school committee. The number of nurses employed is altogether inadequate for the work required. The board of health is ready to employ a corps of nurses to assist in school inspection, but up to the present time, they have not been willing to duplicate a system maintained by the school committee. A transfer, then, of the nurses from the school committee to the board of health would render medical inspection of schools as nearly perfect as human endeavor can accomplish.

“The school population at this date is 123,091. This includes attendance in public and parochial schools. For this work there are employed 82 physicians, who are required to visit every school building on every school morning of the year."

See same, 162: 215, February 17, 1910.

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