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The modern Philippine school building is a model of construction, adapted to the Tropics. There is no heating problem in the Philippines, and as a consequence ventilation is very much simplified. Water supply and sewage disposal are directly under the control of the bureau of health. The pupils are specially trained in the necessity of thorough hand cleansing after using the toilet and before eating. The children have been used also to eliminate the timehonored Filipino custom of eating with the fingers out of one common family dish.
The dense ignorance of sanitary principles and the oriental fatalism of the older generation could not be successfully combated without the aid of the school children. With their aid a very great improvement has been effected.
There is now in Manila a very efficient medical inspection of schools. This is particularly effective because of the splendid facilities of the bureau of health for giving medical treatment. The city is divided into health districts with free dispensaries and hospitals where the school children are treated. In this country the health department can often do no more than recommend treatment. In Manila the child is reported to the bureau of health, and the powers and organization are such that control is easily maintained until the child is returned to school cured. Special attention is paid to the teeth of children, and these are treated in the free dental clinics of the Philippines General Hospital. During the school year ended March 29, 1912, in Manila over 2,400 children were referred to the hospitals and dispensaries of the bureau of health for treatment.
The effect of the teaching and practice of hygiene in the Philippine schools is manifest in the improved physical condition of the pupils, and it is a powerful instrument in the sanitary regeneration of a nation.
XII. MISCELLANEOUS TOPICS.
X. HOW WOMEN'S CLUBS CAN AID THE HYGIENE MOVEMENT.
Bureau of Municipal Research, Vero York, 1. y. The greatest service of women's clubs during the next few years will be to apply everywhere what we already know; to use all the machinery already available in every city and every country; and to carry out definite programs based on the proved experience of other communities.
The cities and towns where there in not adequate medical inspection, examination, and treatment of physical defects, where all school buildings are not properly cleaned, ventilated, heated, lighted, outnumber 10 to 1 the cities and towns where even a beginning has been made.
There is no need for more organizations of women. There is no need for wasting precious time while communities “grow up” to health facts. There is no need for added experimentation about the more important phases of school hygiene, i. e., the physical condition of the children themselves and the environment they go to school in.
May I suggest, therefore, that our “ prophecies and promises " for the next few years group themselves under the following four heads:
1. Use fact-giving machinery.-Women's clubs will use the machinery already in full swing to avoid being handicapped by lack of facts. Reference agencies like this congress, the United States Bureau of Education, bureaus of municipal research, the Russell Sage Foundation, State and local boards of health, tuberculosis associations, etc., are spending thousands of dollars every year getting facts, making them available, answering questions.
2. Draw 100 per cent pictures.-Women's clubs will use the machinery of all organized women, whether in their clubs or in other clubs, to give to their city a 100 per cent picture of school health needs in that city. If an inspecting committee finds one school with unwashed windows and dirty floors, the club machinery will ask, How many more? If 90 out of every 100 children in our schools were found with decaying teeth, club women will ask, How many more? and How can they all be fixed? If a building is found with one open-air room for 20 children and bad air for 980 children in all other rooms, club women will ask, What's the use?
3. Enlist professional cooperation.-Women's clubs will use the machinery of their local medical and dental associations and their local groups of business men to secure (a) publicity about health needs not met; (6) preliminary volunteer examinations; (c) financial support by the city.
4. Solve other health problems.-Women's clubs will use the machinery of the whole city administration to correct conditions affecting the health of school children or school buildings. Constant watching, reporting to authorities specific bad conditions, following up promised improvements, will be given to the questions of clean streets around school and for play; prompt garbage removal; where drinking water comes from; how milk is analyzed; what cake, candy, soda, and ice cream in shops near schools is made of, etc.
B. THE SCHOOL AND VITAL STATISTICS.
FRANKLIN C. GRAM, M. D., Chief of the Bureau of Vital Statistics, Department of Health, Buffalo, N. Y, At first thought it might seem that the school and vital statistics are antitheses and their points of contact about as opposite as the two poles. The same might have been said about medical school inspection only a few years ago. In an age of progress the dead languages give way to technical education and the philosophy of unknown quantities to manual training. Granting this, you will ask, Where will the study of vital statistics fit into the school curriculum?
It needed no argument to make room for the art of bookkeeping. Even the unintelligent recognized the necessity of a knowledge by which, in his crude way, he might measure his financial loss or gain during a given period. Vital statistics is the bookkeeping of a community. It shows the assets as well as the liabilities. It does more. It forms a permanent record of every individual from the beginning to the end of life.
If we teach our children that certain diseases, such as measles and whooping cough, which have been regarded as blessed essentials of childhood, and which our mothers were wont to invite by contact in order to have them over with as early in life as possible, are not essential but more fatal than dreaded pestilence, then we assist them in retaining a normal constitution and possibly prevent them from filling an early grave.
The reduction of infant mortality has long ceased to be a subject of philanthropy or of public spirited benevolence. It is a recognized duty of the State. The State can do nothing without the cooperation of its citizens, and unless its citizens can be made to understand a condition there can be no cooperation, because it then becomes a matter of law and not of duty.
To a proper study of these things it is essential to have some knowledge of morbidity and mortality conditions. It is necessary to know the number of births in a community in order to compare it with the number of deaths. Vital statistics show at what period of life the lowest and highest mortality rates exist, the causes which produce death at later periods, and this again leads to the study of prevention. Connected with this study is a natural inquiry into the causation of disease, and while such study still presents many obstacles to the untutored mind, yet it is within the range of possibility. .
Nor is such study without profit to pupils before they reach high school or college. It is particularly valuable before that stage is reached, because during this period of life many of the contagious diseases occur which cut short a promising career or leave the individual burdened with an infirmity for life.
The study of vital statistics is entitled to a place in schools on the following grounds: (1) It leads to an inquiry into morbidity and mortality conditions of the home locality; (2) it forms a basis for comparison with what such conditions ought to be; (3) it assists in the study of prevention of disease and in the knowledge of public health; (4) it is an essential adjunct to medical school inspection and school nursing; (5) a knowledge of health and disease forms the bulwark of nations; (6) youth is the best period in life for beginning to acquire such knowledge.
C. ACCIDENT PREVENTION AS RELATING TO CHILD WELFARE.
Marcus A. Dow,
Remarkable results have been obtained in the actual reduction of industrial accidents through the education of industrial workers along the lines of safety, in many instances large plants or railroads showing decreases ranging from 10 to 40 per cent in casualties in one year. In a very brief period the plan of systematic education of industrial workers in accident prevention has proved effective and successful. Why should it not be just as successful if applied in schools ? The great need for a concerted, well-defined plan of teaching school children “ sa fety,” 6 prudence," and " carefulness ” is apparent when the great number of lives sacrificed annually is considered.
The railroads do not begin to furnish all the accidents that result in serious or fatal injury to children and others. The dangers that beset the child in daily life are numerous and varied. Matches and bonfires, the automobile, the street cars, vehicles drawn by horses, and many other things contribute to the huge list of deaths and injuries to children from accident causes.
In New York City alone there were 226 children killed and 479 seriously injured while playing in the city streets during the year 1912. In the States of New York and New Jersey during the same year there were 164 children under 16 years of age killed by being struck or run over by automobiles and 935 injured from the same cause. There were 77 killed and 171 injured by trolley cars and 110 killed and 249 injured by wagons, a total of 351 children under 16 years of age killed and 1,355 injured in one year in only two States of the Union on account of being struck or run over by vehicles while playing upon or crossing public streets or highways.
Infection by intestinal parasites is world-wide in its distribution. It is most prevalent in the tropical and semitropical countries, where it is a problem of great magnitude. As a factor affecting the life and the health of the people, their physical and mental development, and their material welfare, its importance has not been generally appreciated. In fact, it has not been particularly emphasized by many of our medical colleges and of course not by the physicians they graduated. Yet in the light of the revelations made during the past three or four years by the Rockefeller Sanitary Commission, working in conjunction with boards of health of 11 Southern States, there should be great reform generally in the methods for acquainting both students of medicine and the laity with the essential facts pertaining to this form of infection.
Types of parasites. During the three and one-half years prior to July 1, 1913, the health agencies above referred to made 665,581 microscopic examinations of specimens of feces for parasitic ova for 665,581 persons; of these 329,578 were found to have hookworm infection and were treated. Private physicians have treated and reported 162,305 additional persons, giving, with those treated by the health agencies, a total of 491,833 treated persons. The hookworm is by far the most common and most important of the intestinal parasites. In 326 counties of the South, infection surveys for hookworm disease have been made. Each survey is based on the microscopic examination of a minimum of 200 country children taken at random, ages 6 and 18 years, inclusive. These surveys indicate that in different counties, varying with their geographical location, the hookworm infection ranges from 1 per cent to as high as 80 or 90 per cent of those examined.
In many localities 80 to 100 per cent of the school children have been found to have the disease and to have made only 50 per cent of the progress made by normal healthy children. In other localities entire families heavily infected have had their systems so undermined that they were swept away completely, either directly by hookworm disease or by intercurrent diseases like tuberculosis, pneumonia, or typhoid fever, which easily overwhelm the devitalized bodies of hookworm subjects. Routine examinations for a series of graded schools have shown hookworm infection three times more prevalent in the backward sections than in the advance sections for the various grades.