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PART n.—STATE ORGANIZATION OF SCHOOL HYGIENE

IN MINNESOTA.

In order to guide and assist local school health departments, whether organized by boards of education or boards of health, we should have State divisions of child hygiene under the various State boards of health in cooperation with the department of public instruction. Minnesota is at the present time the only State that has thoroughly organized such a division.1 In this State the work is carried out under a special director of school hygiene who, under the direction of the State board of health, maintains a clearing house of information at the office of the board and travels about the State in the interests of the work.

The general procedure of the director at each place visited is as follows:

1. A general meeting with all the teachers of the local school system, at which are explained methods for the physical observation of school childen. At these meetings practical demonstrations or clinics are held with one or more grades of school children present, usually a fourth or fifth grade.

2. Individual demonstrations to the teachers at the various grades in different schools.

3. Examination of special cases.

4. A second meeting with all the teachers for the purpose of discussion of the results of observations in the grades.

5. An open meeting devoted to the interests of parents of school children.

6. Inspection of school buildings and premises.

7. Organization of the study of mentally deficient children.

8. Recommendations for health promotion addressed to the board of education and adapted to the conditions discovered.

9. Aid furnished in organizing school health departments according to one of the three or four standards which have been adopted.

10. At normal schools short courses in child hygiene are given. The following letter, which was sent to the various school superintendents of Minnesota, will explain the purposes of the campaign for

1 Virginia has since 1012 undertaken limited State health supervision.

school hygiene undertaken by the writer of this report, under the direction of the executive officer of the State board of health:

RELATING TO HEALTH SUPERVISION OF SCHOOL CHILDREN.

State Board Of Health,

St. Paul, August, 1912.

The State Board of Health and the Department of Public Instruction of Minnesota wish to lend their aid to the schools of the State in promoting health supervision of school children. To this end, the State Board of Health has engaged the services of Dr. Ernest B. Hoag, formerly of the University of California and at present on leave of absence from Stanford University, to help Minnesota towns and cities to organize health work in schools.

Dr. Hoag will travel about the State, spending from one day to several days, as may be required, in the various places needing his services.

It is proposed to demonstrate to towns, cities, and counties that rational conservation of the mental and physical health of our school Children is possible and practical with the means already at hand. Three plans will be proposed:

(1) Organization with a medical officer and nurse or nurses.

(2) Organization with school nurse or nurses only.

(3) Organization by the employment of a simple nonmedical health survey on the part of the teachers only. Such a survey is provided by a series of questions based upon ordinary observation of physical and mental conditions. The outline for this purpose will be furnished by the State Board of Health—one for each child. No community need wait for the employment of a medical officer in order to begin sensible health observation of school children.

Dr. Hoag will be available for lectures on child hygiene, medical supervision, and related topics, for clubs, institutes, and various other orgnlzations. The State Board of Health will maintain in its office in the Capitol building, St. Paul, a clearing house of information concerning child hygiene, medical supervision, the teaching of school hygiene, sex hygiene, and the like. Please make full use of the opportunities furnished in this new work. Tour cooperation is earnestly desired.

For further information address Dr. H. M. Bracken, Secretary, State Board of Health, St. Paul; or Mr. C. G. Schulz, Superintendent of Public Instruction. St Paul.

Requests for assistance in organizing departments of school hygiene and health supervision were received from a large number of towns and cities, and from these the secretary of the State board of health selected 67 to be visited by the special director of school hygiene. It was found quite impossible to meet all the requests from the various superintendents of the State, and it was evident from the beginning that the demand for aid in health organization in schools was far greater than could be met by any possible means at hand. It was. therefore, decided to select in the main the larger places of the State, in order that the influence of the work might extend as widely as possible.

In order to indicate the usual methods of procedure, several reports of the director to the secretary of the board are here given.

RECORD OF TRIP TO GRAND RAPIDS, MINN., AUGUST 28-30.
Population, 2.600.

I left St. Paul Tuesday, August 27, arriving at Grand Rapids on the 28th, to lecture at the Itasca County Teachers' Institute.

On the afternoon of August 28, a lecture was given to the teachers assembled on the topic, "The Health Grading of School Children." The teachers were much interested in the plan proposed, which was as follows:

(1) A series of leading questions to be answered by the pupils themselves when old enough, and when not old enough by their parents, concerning their own physical condition, these questions to be answered on blanks furnished by the teacher and given to her by the State board of health.

(2) A series of questions, nonmedical in nature, depending merely on careful observations, to be answered by the teachers themselves on the same blanks as above mentioned.

The teachers showed a disposition to cooperate heartily in this plan. They were told that they could receive the blanks mentioned at any time upon application to the secretary of the State board of health.

In the evening of the same day a public lecture was given which was attended by both the people of the village and the teachers. The subject of the lecture was. "The Physical Observation of Children," and it was illustrated by lantern slides. Interest was shown in this lecture by the fact that a considerable number of questions were asked by those present.

On the morning of August 29 a lecture was given on the topic, "How to Teach Hygiene in Schools." A plan was proposed by which textbooks are to be used largely as reference guides, but the course is to be based upon common sense application of health principles to local needs. It was announced to the teachers that an outline for such course had been prepared and would be furnished later by Mr. C. G. Schulz, superintendent of public Instruction.

Relating to medical supervision of schools.—Prof. Freeman, district superintendent of schools in Itasca County, held a conference with me in respect to the organization of medical supervision in the schools of Grand Rapids. He stated that $1,000 was available, in addition to the services of a district nurse, for this work. He requested information on how to make the best use of the money available. The following plan was proposed to him:

That he base the salary of a school physician on the rate of $1 per pupil and expect of this physician a complete health survey of all school children, with a careful record for each child; and in addition a general supervision of the sanitation of the school buildings and grounds and such special work as he may be called upon to do by the superintendent of schools, particularly in respect to communicable diseases and the unhygienic conditions of the children as relating to certain parasitic conditions of the skin and head.

It was proposed to Prof. Freeman that the person appointed to the office of school physician ought to be allowed sufficient money to cover the expenses of a visit to St. Paul, Minneapolis, and Milwaukee, in order that he might make a thorough study of health supervision of schools In the three cities, and it was further suggested that he consult with Dr. Keene, of Minneapolis, the State board of health of Minnesota, and Dr. Barth, of Milwaukee. Prof. Freeman assured me that the plan as outlined above would be put into operation. I feel that Grand Rapids Is to be congratulated on its plan for organizing what seems to me an Ideal method for a village of its size, and I hope that other villages Of similar size will take this plan into consideration in respect to their own needs.

[note.—In September medical inspection of the Grand Rapids schools was organized and placed in the hands of four local physicians. This is not an Ideal plan, as there is no one person responsible for the work. An investigation of the work done by these physicians was made by me in November, and it is only fair to say that they had examined every pupil in the schools, made careful records on card copies from the Duluth plan, and had In general accomplished much good.]

RECORD OF TRIP TO HIBBING, MINN., NOVEMBER 11-13.
Population, 15,000.

The Hibbing schools were visited on November 11 to 13, inclusive. The teachers were met as usual and the use of the Outline explained to them, and afterwards 14 grades were visited and the children in those grades observed. About 20 special cases were called to my attention by teachers, and these were given a thorough examination, and proper recommendations were made to suit each individual case. I found a special teacher employed in the Hibbing schools for the study of retarded pupils. This teacher has had extensive training, is competent, and is accomplishing much good. Her special effort is, first of all, to distinguish between retarded children who are curable and retarded children who are incurable—in other words, to distinguish between dull and mentally defective children. She Is thoroughly familiar with the use of the Binet system, and already has made use of it in connection with a large number of children. The effort at Hibbing is to give the individual child as much attention as possible and to provide proper education for mentally peculiar children, whether their condition is due to dullness or mental defectiveness. Two ungraded rooms have already been established, and the teacher of one of them has had unusual opportunities for the study of children of this type. Children in the Hibbing schools are advanced by subjects rather than grades. Therefore each grade Is divided into several divisions, sometimes as many as four or five, in order to make this form of promotion possible. Taking everything into consideration, the school system at Hibbing is the best that I have yet had the opportunity to observe.

In respect to sanitation the schools are in excellent condition. Hibbing schools are provided with medical inspection, and for this purpose have employed Dr. Lea for his full time, paying him $1,800 per year for his services. The doctor occupies three rooms in the high-school building—a waiting room, a consultation room, and an emergency room. The equipment of the medical officer is the most complete I have seen in any school, either in Minnesota or elsewhere, and leaves nothing to be desired. The equipment includes practically everything that would be found in a modern physician's private office. The schools have spared no expense in this equipment. It includes a complete laboratory outfit of the very best sort; apparatus for the examination of the eyes, ears, nose, and throat, such as is used by specialists; a hospital bed ready for occupancy in case of emergency; an operating table for use in case of accidents; and a well-equipped medical library. The medical officer spends several hours each day in his office, so that teachers may send pupils to him for examination. During the rest of the time he visits schools in the district, which covers a very considerable area. Free medical treatment is given to school children by the school physician of Hibbing in such cases as are unable to secure regular medical attention.

The following suggestions were made in respect to the present medical inspection system at Hibbing:

(1) A school nurse should be employed at once, for it is apparent that notices sent to parents by the school physician receive very little response. This Is explained to a large extent by the fact that there is a large foreign element. A school nurse who has had some training in social service work could accomplish wonders in this community.

(2) The purchase of about 20 books for the school physician's library on subjects pertaining to school hygiene was recommended; also subscription to a number of Journals on the same topic.

(3 It was recommended that the teachers cooperate to a greater extent with Dr. Lea by making use of the Health Outline provided by the State board of health, so as to relieve him from the necessity of examining a grent many perfectly normal children, and also to acquaint the teacher more fully with conditions present in her own room.

(4) It was demonstrated to the teachers that the use of the Health Outline would provide them with Information about conditions in respect to the school children which would form the best possible basis for practical hygiene instruction.

All of these suggestions were accepted by the superintendent of schools and will, it Is believed, soon be put into effect

I was requested to spend two days more In the Hlbblng schools In the near future to make an examination of special cases and to offer suggestions relating thereto. The conditions of the homes of the children in the Hibbing schools are, in many instances, bad. For this reason more careful attention should be paid to proper hygiene here than in most schools, and there is urgent necessity for the services of a reliable and tactful school nurse.

RECORD OF TRIP TO CHI8HOLM, MINN., NOVEMBER 14-16.

Population, 7,685.

I visited Chisholm on November 14 and 15. In respect to the sanitation of the Chisholm schools there Is nothing to recommend. They are in every respect all that could be desired. Not a single room was lacking in proper ventilation or proper lighting, and all other sanitary conditions meet the highest possible requirements of a school system. I found paper towels In use, Individual soap containers, sanitary sweeping employed by the use of oiled sawdust, a perfect system of ventilation by the direct-indirect method, ventilated coat closets, lighting in every case sufficient and from the left side, halls splendidly lighted, walls tinted in the most desirable manner, and altogether the schools most attractive and artistic. The attention of all the other schools of Minnesota ought to be called to the ideal sanitary conditions existing in the Chlpholm schools. The only point which could be criticized was that of temperature. Some of the rooms registered a temperature of 74 or 75, which is 6 or 8 degrees higher than desirable.

The employment of a social service school nurse was recommended and the idea was favorably considered by the board of education.

RECORD OF TRIP TO MANKATO, MINN., OCTOBER 15-24.
Population, 11,000.

Mankato was visited October 15 to 24. In addition to the usual preliminary meeting with teachers, a second meeting after the demonstration of work In the grades was held for the discussion of results obtained. All of the grades

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