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PART III. THE SCIENTIFIC EXHIBIT.

CONCRETE DATA OF THE SCHOOL HYGIENE MOVEMENT AS SHOWN IN THE EXHIBIT.

1. MEDICAL INSPECTION.

Boston, Mass.-The division of child hygiene 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 of this division is classified into three subdivisions, as follows: (1) Prenatal and postnatal; (2) medical inspection of schools; (3) physical examination of licensed minors.

Physical examination of school children for the year 1912–13 showed the following results:

Total number of pupils examined----
Total number of pupils without defects-
Total number of pupils with defects__

121, 832

52,499

69, 333

The defects noted were: Mental deficiency, 391; defective nasal breathing, 9,174; hypertrophied tonsils, 24,720; defective teeth, 60,709; defective palate, 366; cervical glands, 11,370; pulmonary disease-tuberculous 66, nontuberculous 1,165; cardiac disease, 2,796; nervous disease, 303; orthopedic defect-tuberculous 103, nontuberculous 3,154; skin disease, 3,768; rickets, 644; malnutrition, 2,620.

Buffalo, N. Y.-Medical school inspection in Buffalo is divided into four general divisions: (1) Prevention of communicable diseases; (2) detection and removal of physical defects; (3) child psychophysiology; (4) sanitary condition of the school buildings and environments.

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The following is a résumé of some of the work:

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Cincinnati, Ohio.-The bureau of medical inspection and relief is organized with the following officers: Chief school inspector, with a salary of $1,800; 16 district physicians, 11 on full time and 5 on part time, to whom a total salary of $18,275 is paid; 14 school nurses, $10,920; 1 chief dental inspector, $1,500; 4 dental operators (part time), $2,000; 2 clinical assistants, $1,100; 1 clerk, infectious diseases, $1,000; 1 clerk, tuberculosis records, $800; fumigator, $900; 1 chief medical inspector and assistant health officer, $2,750. Their functions are: School inspection, medical relief of the poor, surveillance of infectious diseases.

The hours of medical inspection are 9-12 a. m., 2-3 p. m. Twentytwo public schools and 35 parochial schools, a total of 57, have medical inspection only, without the school nurse. In 43 public schools and 12 parochial, a total of 55 schools, both doctors and nurses are employed. The average number of pupils for each nurse is 2,350. During the period from September 10, 1912 to June 19, 1913, the school doctor handled the following cases:

Excluded on account of infection disease or contact_
Inspected after 4 days' absence_-_-

113

Examined but not needing treatment_

Received for treatment ____

Total number of examinations of children.--

6, 331

13, 537

14. 679

35, 57$

In the same period the school nurses' activities were as follows:

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Cases refused treatment and pending.

School treatments given.

Home visits___

1.076

8,053

4.731

"The nurse is the connecting link between school and home." A survey of 36,438 pupils in public schools, April 21 to June 6, 1913, showed:

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This is urged as an argument for (1) more open-air schools and low-temperature rooms: (2) new school for mentally deficient chil

dren.

Among defects diagnosed by school physician were: Defective vision, 2,135; diseases of the eye, 298. Of these, 1,092, or 44.9 per cent, were corrected by glasses and treatment. Hypertrophied tonsils, 2,692 cases noted, operative, 642; medical, 650, a total of 1,292, or 48 per cent treated. Defective teeth, exclusive of dental inspection, 1,754; cases finished, 1,002, or 57 per cent. Medical and surgical miscellaneous, 1,996; treated, 1,501, or 75 per cent. Children inoculated against smallpox, September 10, 1912, to June 19, 1913, 4.686; of these 97.3 per cent were successful, 52 were unsuccessful, and 76 unknown.

Detroit, Mich.-Results of medical inspection of schools, September, 1912, to June, 1913:

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Eight nurses were employed at a total expense of $1,800, and 33 doctors ($11,500), or a total cost of $16.350.

Jacksonville, Fla.-Medical inspection of school children in Jacksonville, Fla., showed that 77.1 per cent of all the children examined were defective in one or more particulars. The following are the

percentages for the various defects: Hypertrophied tonsils, 36.6 per cent; defective vision, 25.8 per cent; enlarged cervical glands, 9.1 per cent; adenoids, positive, 5.2 per cent; nasal breathing, 3.8 per cent; skin diseases, 2.5 per cent; hookworm, positive, 2.3 per cent; malnutrition, 0.85 per cent; anemia, marked, 0.8 per cent; defective hearing, 0.65 per cent; conjunctivitis, 0.2 per cent.

New York, N. Y.-The work of the division of child hygiene is thus outlined:

(1) Inspection for the determination of infectious diseases; (2) inspection and treatment of contagious eye and skin diseases in school; (3) examination of pupils for certain physical defects; (4) follow-up visit by nurse to home to secure treatment for noncontagious physical defects; (5) treatment at clinics for eye, ear, nose, and throat; (6) treatment of teeth at dental clinics.

School medical inspection is organized under a director and assist ant director for the entire city, with a separate organization for each of the five boroughs in charge of a borough chief inspector. Under each borough chief is a corps of supervising inspectors and supervising nurses, who direct in turn the routine medical inspectors and school nurses. In the year 1912-13 there were 825,664 children in public and parochial schools of New York City under medical inspection. The cost of carrying on the work was $364,300, or 44 cents per capita. The chief medical inspector for each borough has oversight of the clinics for school children.

Philadelphia, Pa.-The scope of the work of the department of medical inspection of schools is described as follows: (1) Detection and correction of physical defects; (2) detection and exclusion of contagious disease cases; (3) sanitary inspection of school buildings; (4) examination at their homes of absentee children, in order to determine whether such children should be excused from school; (5) the examination of applicants for the position of school janitor; (6) examination of high-school boys entering into athletic contests; (7) a clinic for the examination of mentally deficient children; (8) special medical supervision of three open-air schools; (9) free vaccination of school children. The organization is as follows: (1) Public schools, medical inspection (under bureau of health and board of education); (2) public schools, nurses (board of education and bureau of health); (3) private schools and parochial schools, medical inspection (under bureau of health); (4) eye dispensary for school children, No. 1 (for all school children), under bureau of health; eye dispensary for school children, No. 2 (public school children), bureau of health and board of education; (5) dental dispensary for school children, No. 1, for all school children (under bureau of health); dental dispensary for school children, Nos. 2,

3, 4, for public school children, under bureau of health and board

of education.

A general summary of medical inspection in Philadelphia for 1912 shows:

Number of pupils in elementary schools__.

Number of pupils in high schools..

Number of school buildings__.
Visits made by supervisors.

Visits made by assistant inspectors-

Pupils sent to inspectors by teachers..

Routine physical examinations_____

175,905 11, 502 280

1.355 35, 556

98,-171

111, 854

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Time lost from school by reason of exclusions, minor contagious diseases only-‒‒

.__days__

4,314

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The following is a table showing physical defects recommended for

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Republic of Mexico.-Mexico has had medical inspection of schools since 1896. Begun in a small way in that year, it was considerably extended by an act of 1908. Annual salaries and expenses for the work increased from $2,000 in 1896 to $52,000 for the year 1912-13. During the same period the number of medical inspectors has increased from 1 during the first three years to 43 in 1913. About 5,500 children are now assigned to each school doctor.

Of diseases found in school children in Mexico City 1908-1912, those of contagious type most frequently found are pediculosis (15 per cent) and ringworm (41 per cent). In the noncontagious diseases anemia led with 19 per cent; 29 per cent of the children have defective vision, 27 per cent dental caries, and 5 per cent defective hearing.

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