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percentages for the various defects: Ilypertrophied tonsils, 36.C 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 assistant 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 175. 0O5
Number of pupils in high schools 11, 502
Number of school buildings 2S0
Visits made by supervisors 1. 355
Visits made by assistant inspectors 35, 556
Pupils sent to inspectors by teachers 98,-171
Routine physical examinations 111, 854
Special examinations (classrooms) '- 317,504
Defects recommended for treatment 13S. 092
Proportion of physical defects corrected percent-.: 45
Exclusions from school 046
Time lost from school by reason of exclusions, minor contagious diseases only days-- 4. 314
Number of throat cultures taken 2, 722
Number of throat cultures with positive results 41S
Vaccinations performed 312
The following is a table showing physical defects recommended for treatment at two different periods:
Defects: . 1912. 1913.
Eye 25, C56 10. 510
Nose, throat, and mouth 37, OSS 22. 946
• Ear - 2.249 1,470
Teeth 5^ 047 40. 345
Orthopedic 2. 049 1, 686
Anemia and i>oor nutrition 2.543 1,434
Nervous 035 G70
Heart— 367 587
Defective mentality 163 1SS
Skin 10,386 10.144
Miscellaneous 2. 054 2. 552
Total 142.536 OS. 502
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 (4J 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. n. THE SCHOOL NURSE.
Buffalo, X. Y.—School nurses in 1912 made 1,703 school visits and 2.014 home visits, of which 600 were to contagious and 1.414 to noncontagious cases. Total inspections were 10.411.
Treatment or instruction was given as follows: Pediculosis. 1,364 cases; ringworm. 40; favus, 13; scabies, 184; impetigo, 470; skin, 1.201; eyes. 1.308; ears, 564; vaccinations, 379; miscellaneous, 2,381; dispensary v 43.
Philadelphia, Pa.—The bureau of health of Philadelphia shows the direct value of the school nurse service by comparing conditions with and without nurses. A saving of nearly five days is obtained on every case of contagious disease by means of the school nurse service. The statistics show that the average number of days lost by school children when the schools are without school nurse service is 5.06458. The average number of days lost when the schools have nurse service is found to be 0.34268. Lack of nurse service is therefore responsible for 4.72191 days of preventable loss. Multiplying 4.72191 (preventable) loss (average days) by 16.884 cases of minor contagious diseases handled by school nurses gives 79.725 total days of school time saved to these school pupils through nurse service. The per capita cost of education in Philadelphia is 18\ cents, so that $9,122.05 is saved to the educational system through this one branch alone of the school nurses' activity. The total cost of school nurse service from February, 1912, to June, 1913. was $25,760. The nurses were employed in the congested districts of the city.
Another proof of the importance of the school nurse is found in the follow-up results. Irrespective of social grade, more physical defects are corrected with nurse than without. Four groups were studied: In group white, native, social grade A, 43 per cent of defects were corrected with nurse, as compared with 36 per cent when no nurse was employed. In group white, grade B. 50 per cent were corrected with a nurse, and 43 per cent without. In white, grade C, 50 per cent were corrected when a nurse was employed, whereas only 18 per cent were corrected when there was no nurse. In colored, grade C. 63 per cent of defects noted were corrected with the nurse, as against 22 per cent without a nurse.
Rochester, X. Y.—School nurses in Kochester paid 1,269 visits to homes; took 853 cases to dispensaries and hospitals; cared for 1.906 defects; found 306 defects of eyes; 461 of ears, nose, and throat; 273 of teeth; 267 skin diseases: 413 miscellaneous defects.
m. ORAL HYGIENE.
Connecticut.—In Hartford there are free dental clinics for school children supported by the Hartford dental society. In Waterbury there are two dental inspector*, salary $000, paid by the city. Ia Bridgeport the city appropriates $500 for the dental clinic of the Bridgeport dental societ}\ New London has a dental clinic equipped by the board of education and maintained by the New London dental society. Other Connecticut towns report as follows: Stratford— examination by an individual dentist, but no town appropriation; New Britain—examination of the children by the New Britain dental society; Greenwich—clinic established by the United Workers; New Haven—room secured in a school building for a privately supported clinic; Meriden—school children examined by the Meriden dental society, but no appropriation.
Kentucky.—Dental inspection and clinics in 17 communities throughout the State.
New York.—The State department of health is conducting an active oral hygiene campaign by means of elaborate exhibit material, which includes a model clinic.
Pennsylvania.—Thirteen free dental dispensaries are in operation. Besides the 5 in Philadelphia, there are 2 each at Pittsburgh and Wilkes-Barre, and 1 in each of the following cities: Scranton, Philipsburg, Reading, Chester.
Boston, Mass.—The Forsyth Dental Infirmary. Boston's answer to the oral hygiene problem, is to be opened in 15)14. Its work will be to care for the mouth conditions of all the children of Greater Boston up to 16 years of age. Attention will be given to adenoids, hair lip, tonsils—in short, the whole subject of mouth, nose, and throat. Follow-up work will be done by the school nurse and social secretary. Patients will be required to return to the infirmary three or four times a year for examination, treatment, and advice. The institution will have facilities for 04 chairs, with room for 41 additional: each chair having a capacity of 12 patients per 8-hour day, or a total capacity of 768 patients daily. There will be a lecture room for public lectures on hygiene and oral prophylaxis.
Cincinnati. Ohio.—-Mouth lwgiene is supervised in Cincinnati through a cooperative arrangement between the Cincinnati dental society and the board of health. The board of health provides 1 chief dental inspector, 4 dental operators, and 2 clinical assistants. The dental society furnishes 56 dental inspectors and 30 lay volunteers. The number of children examined in different years was: 920 in 1909; 4.594 in 1910; 8,432 in 1911; and 12,000 in 1912.
Follow-up work in two typical schools:
First school. Second school.
Number inspected 664 Number inspected 326
No defects 74 No defects 22
Treated at dental clinic 12S Treated at dental clinic 99
Treated by family dentist 290 Treated by family dentist 116
No treatment 120 No treatment 8
Withdrawn from school 55
Cleveland, Ohio.—In 1910-11 Cleveland was the scene of the national mouth-hygiene campaign. The National Dental Association supplied equipment for clinics, a trained nurse and finances for the Marion School class. The Ohio State Dental Association paid for the printing and furnished the use of a stereopticon. The Cleveland dental society furnished the examining clinicians and lecturers. Rooms were furnished hy the Cleveland board of education, by the library, and by St. Alexis Hospital. The campaign had for its object:
To bring to the attention of the people, hy means of dental inspection of an adequate number of children, the universal need of dentnl service: to show by means of clinics that there is a great demand for dental service by indigent children; to present to the people by means of lectures the great value of mouth hygiene in the general welfare of the child: to show by means of the Marion School class the results possible to be obtained from an ideal method of instruction in the care and use of the mouth, accompanied by the correction of the faulty oral condition.
As a result of this campaign, 20,861 pupils were examined. The mouths of 97 per cent were found faulty. The six clinics were operated for a total of 834 half-days: 372 patients were treated; 2,217 operations were performed; and 49 lectures were delivered at the ATarious school auditoriums to parents of the older grade pupils.
From a school of 84fi pupils there were selected 40 children presenting the most faulty oral conditions, 27 of whom acquiesced in the plan, followed instruction, and took the tests. The children were