in the schools above the second were visited by Supt. Sperry and myself A parents' meeting was held in the high school the evening of October 16. As the audience was small, the occasion was turned into a round-table discussion, in which I was called upon to answer many questions. Five lectures were given to the senior class of the normal school on the general subject of "Physical observation of school children." All of the grades in the normal training school above the second were visited in the usual way. Demonstrations were given before the teachers of the normal training school. Most of the schools of Mankato were built many years ago, and therefore are open to criticism from a sanitary point of view. While the ventilation is good in nearly every instance, the lighting is frequently bad. It was interesting to notice, however, that the paper towel, the liquid soap dispenser, and the drinking fountain were installed everywhere. The janitor service seemed to be excellent. One of the principals in Mankato has undertaken to make a special study of the mentally peculiar child and for this purpose is to make use of the Binet system after some instruction from me. Personally, I observed in the Mankato schools eight mentally defective children. Mankato needs the services of a school nurse on full time. It would also be very desirable if an arrangement could be made with the local health officer, who is not in the practice of medicine, to devote a portion of his time to health work in schools. The present health officer is admirably adapted to this sort of work. THE USE OF THE HEALTH OUTLINE.1 The Outline for the Health Grading of the School Child was put into use in every town and city visited. Teachers have found it easy to use, and requests for copies of it have been received from nearly every State in the Union, indicating that schools everywhere are looking for methods of health observation which teachers can readily employ. In order that teachers might understand the significance of answers received to the questions of the outline, the following explanations were given in some detail at meetings held with the teachers: SUGGESTIONS FOR USING THE OUTLINE FOR HEALTH GRADING. 1. Call the pupils, one at a time, to the desk. Begin with Part I, and ask the questions as they appear in the outline and write the answers yourself. One can get a great deal of information by noticing how the pupil answers the question. Mistakes in answers may often be corrected in this way, when they would not be observed if the pupil were to answer the questions himself in his own writing at his seat. Do not suggest the answer. 2. In asking questions about headache and earache or any other questions where the word "frequent" appears, use the word "frequent" as meaning once a week or oftener. 3. Be perfectly sure that the pupil understands the question, and test his answer in a number of different ways where you have any reason to doubt the reply given. 4. It is desirable to have the Outline for Health Grading completed for every pupil in your room before the arrival of the visiting physician (if there is one). 1 See also p. 16. 5. After the completion of the health grading in your room, on your part, make a list of the pupils who you think ought to receive further examination by a physician or nurse. Where only the minor difficulties are discovered, it is not necessary to call the attention of a physician to these points, although it may sometimes be necessary to inform the parents of what you discover by means of the blank notice. Do not place any pupils on the list to be examined by a physician unless you have a definite reason for doing so. 6. Make a list of all the retarded pupils in your room, and of this number indicate those whom you suspect of being mentally deficient. SIGNIFICANCE OF THE ANSWERS TO THE QUESTIONS OF PART I OF THE OUTLINE. The answers in Part I will furnish information on the following points: (1) Retardation, (2) influence of previous sickness on present condition, (3) relation of home habits to individual health, (4) condition of the teeth, (5) condition of the eyes, (6) condition of the ears, (7) condition of the nose, (8) condition of the throat, (9) amount of work done out of school, (10) food habits. Defective teeth.-If a child in the third grade or above has never been to a dentist, it is presumptive evidence in most cases that his teeth are defective. Testimony of aching teeth always indicates defective teeth; sound teeth never ache. In nearly every room it will be noted that several pupils make use of a family toothbrush. Nothing could more effectually spread disease than this practice. Practically every disease that we know is spread by the secretions of the nose and throat. This clearly indicates the danger from the use of the common toothbrush. Chronic headache.-Chronic headache in school children is usually caused by one of the following conditions: (1) Eyestrain; (2) indigestion; (3) constipation; (4) auto-intoxication, or absorption of the products of fermentation from the intestines; (5) decayed teeth; (6) bad ventilation at home, or at school, or both; (7) malnutrition; (8) adenoids. Although there are some other causes of headache, they are so infrequent as to be negligible here. Of the above causes given, eyestrain, constipation, and auto-intoxication are probably the most common. Eyestrain. Blurring of the print always indicates some form of visual defect and is therefore positive evidence of eyestrain. It is always well to ask if the pupil habitually sees double; also if he notices spots before the eyes, if the letters appear to move, or if he sees colors. Earache. Chronic earache always indicates more or less serious trouble. It means that inflammation is present in the ear. In many cases earache is due to the presence of adenoids. Adenoids are thus often indicated by earache. Earache, if not corrected, very frequently leads to more or less permanent deafness. Discharging ears.-This condition is more serious than earache and indicates that the disease process in the ears is advancing rapidly. The condition should always be treated at the earliest possible time. Always test the hearing of pupils who have earache or ear discharge by means of the watch tick or whispered words. As a check in this test, always test children with normal hearing at the same time. Difficult nasal breathing.—Children who complain of constant difficulty in breathing through the nose usually have adenoids. Sometimes the obstruction is in the nose itself and in this case is due to enlarged turbinates or polypi. Many children with adenoids will say they can breathe easily through their noses simply because they have never breathed normally and do not, therefore, know what nasal breathing means. Inquire if the child's mouth is usually dry when he wakes in the morning. A frequent sore throat.-This condition nearly always indicates diseased tonsils, and diseased tonsils should always receive prompt attention. If the tonsils are much enlarged, adenoids will nearly always be found present. On the other hand, adenoids are often found present when there is no enlargement of the tonsils. Rheumatism is often associated with diseased tonsils. So-called "growing pains," stiff neck, and tender aching joints are common symptoms of rheumatism. SIGNIFICANCE OF ANSWERS TO PART II. General appearance.-There are many reasons for poor general appearance. The most common is probably general malnutrition, due commonly to insufficient food, or the wrong variety of food, or the wrong use of food. Some other causes are the following: Adenoids, diseased tonsils, bad ventilation, very rapid growth, tuberculosis, a recent sickness of some sort, very defective teeth. Peculiarities in posture, walk, etc.-These conditions may be explained in general by weak muscles, due to rapid growth; spinal disease; flat-foot or broken arches; rickets; tuberculosis; paralysis from some serious disease, such as infantile paralysis, meningitis, or diphtheria. Mental condition.-A child who is two years or more retarded in school, who does not play normally, who is not mentally alert, should always be suspected of being mentally deficient. He should be tested by the Binet method. It is necessary to distinguish between merely dull and mentally deficient children. Many mentally deficient children show none of the physical signs of such a condition, and they may be the best looking children in the class. Be careful not to overestimate the intelligence of the old, mature child who is two or three years retarded, even though he does fairly good work in a class of much younger, less mature children. He must be judged by the ability of children of his own age and not by children younger than himself. Nervous condition.-Stammering is nearly always a nervous condition and not usually due to physical defects. Nail-biting is almost never a mere habit, but is caused by an unstable condition of the nervous system. Spasmodic movements should always be carefully observed, as they often indicate St. Vitus dance or habit spasms. True hysteria is very seldom observed in school children. General nervousness is indicated by a lack of repose, too much emotion, and inability to keep quiet, and may be due to a large number of causes. Sometimes the home conditions will offer the explanation. Often the child is from a nervous family. Sometimes it is due to bad sexual habits, but more often the sexual habits are due to an unstable nervous system. Socalled "bladder trouble" is practically always a sign of general nervousness and usually has nothing to do with the condition of the kidneys at all. Nose and throat.-Adenoids are usually indicated by a nasal voice, frequent colds, crooked and prominent teeth, mouth breathing, and mental dullness. Not all of these conditions are always present, but some of them are. Adenoids and enlarged tonsils are usually associated. Ears. Never forget the relation between adenoids and earache, discharging ears, and deafness. Constant bad spelling sometimes indicates deafness. Eyes. Children with crossed eyes always have a defect of vision, and the crossed eye will in time usually become blind or nearly so. These children should have properly-fitted glasses at the earliest possible moment. This will often straighten the eyes and save the sight. Defective eyes are often indicated by red lids or red eyes, blurred vision, or double vision. The teacher should test the sight of each child by using the Snellen test type. Skin.—Any sudden eruption should always be noted, as possibly indicating a contagious disease, such as measles, chickenpox, scarlet fever, or the like. No sort of skin disease should ever be ignored. The cause of it must be discovered. Examine the teeth of the children.-Stand in a good light, have the children file past you and open their mouths as widely as possible. Take a quick look at all of the teeth and make a note of each child who has defective teeth. It is not necessary to note the number of such teeth as every defective tooth ought to receive immediate attention. Some general observations.-Try to discover what children always have coated tongues. This is almost always due to constipation. Try to correct this condition among children, as it is extremely common and usually receives very little attention at home. Attempt to learn the home habits of the children under your care. You will be surprised to learn how many keep very late hours. Try to learn the cause for this. Try to learn how many children eat candy every day. Talk to them about bathing habits and learn what their habits actually are in this respect. Make a list of the children who live in families where there is chronic sickness and discover what the sickness is. Always be on the alert for signs of children's contagious diseases, when they first manifest themselves. Use the information obtained by the outline for practical teaching in matters of hygiene in your particular room. This will furnish a more effective basis for useful health teaching than anything else. The State board of health offered to schools that desired to organize school health work blanks for recording examinations. It is important that school health records be standardized, and it was therefore recommended that the record cards furnished by the State board of health be employed in all schools about to organize health supervision. The record cards as furnished by the board are reproduced below. Either a general health survey or a school clinic was carried on in every school community visited. In general the results of these surveys and clinics are very similar, and for this reason it is not considered advisable to publish all of the results obtained by the director of school hygiene during the year's campaign. The statistical results obtained in five typical cities follow: 1 Blank spaces indicate that the question was not asked or the examination was not made. |