I enter a schoolroom and ask the teacher to request all the children who have the toothache to rise... These go to the operating room and are attended to.

"The reports of the work as it progresses are daily brought to me by the assistant, who occupies a vacant room in the school building, and who operates from 7.30 until 12, and sometimes until 1 o'clock. "All these clinics, except the one in the schools-and that lives by reason of the others are connected in violation of law, but . . . under a provisional sanction. . . . I have made repeated efforts since 1903 to have the law amended so that (at first) such clinics might be established, and (since 1905) when they were established, that they might continue-but without success. . . . The donations to the clinic are valued at about $900.... My own services are given without remuneration. . . . The hospital gives quarters to the clinic free of rent."

See also Dental cosmos, October 1911 and November 1912.

Philippine general hospital is establishing a dental clinic to be in charge of author.

RHODE ISLAND.

COLTON, James C. The dental condition of children in the Providence public schools. Dental cosmos, 51: 876-80, July 1909.

"Of 1203 children examined, 1161, or 96.6 per cent had decayed teeth and 557 or 46.3 per cent had suffered from aching teeth within two weeks. . . . In the technical high school, where 100 young men were examined, 96 were found to have decayed teeth. . . . Of the 1203 examined, only 19.2 per cent used a toothbrush at least once a day; 37.7 per cent used a brush not less than once a week but not as often as once a day, and 43.1 per cent never used a toothbrush.

"Believing that nervous diseases and lowered vitality (due to abnormal oral conditions) contribute to a low standard of scholarship, I visited the ungraded rooms at the Benefit Street and the Chalkstone Avenue primary schools and there examined 39. . . . I found that every child had decayed teeth ranging in number from one to ten; 23 had aching teeth; 19 had been disturbed while sleeping by aching teeth within two weeks, and 14 could not eat without pain from carious teeth.

"I believe... there are over 27,000 public school children [in Providence] in need of immediate attention, and if 46.3 per cent of the public school children are suffering from toothache, there are 13,000 whose nerve condition is abnormal and who cannot reasonably be expected to attain a satisfactory standard of scholarship."

Providence. School committee. [Report of the Dental inspector] In its [Proceedings] no. 40 [Series E] February 23, 1912. p. 434-35.

The first year's work, ending January 26.`

An examination of 4,418 children, "of whom 4,131, or 93 per cent, were found to have decayed teeth; 289, or 6.5 per cent, had sound teeth; 1,083, or 24.5 per cent, were found with aching teeth. Only 189 children out of 4,418, or 4.3 per cent, had received dental treatment previous to the examination. As a result of the examination and recommendation to the parents, 1,009 children, or nearly 24.4 per cent of all those whose teeth needed attention, have received 3,430 dental treatments an average of over three treatments to each child."

THE SCHOOL NURSE.

GENERAL REFERENCES.

ALLPORT, Frank. The school nurse. American academy of medicine. Bulletin, 13: 145-50, June 1912.

"It is, of course, desirable that each nurse shall have but few schools to care for, in order that individual necessities shall be relieved in the best manner possible. No nurse should have under her care more than 1,000 pupils, indeed, one nurse can hardly care for more than one school and do her work satisfactorily, and I greatly question whether even this is not too much labor to expect of any one woman.

"This opinion can perhaps be better understood, if an effort is made to acquire some i lea of the multitudinous duties of the average school nurse. In the first place she shall act as first assistant to the medical inspector,, and shall always be in attendance when he makes his visits to the school. By observation and consultation with the teachers, she finds sick and ailing children and submits them to the inspector. The carrying out of the inspector's orders is placed in her hands, whether this is done at the school, home, or hospital. Many cases of skin diseases, lice, filthiness, etc., are cared for at the school by the school nurse, under orders from the medical inspector, and in schools possessing bath tanks, etc., they are operated under the supervision of the school nurse. One of the principal functions of the school nurse is to see that the doctor's orders are carried out. The doctor may diagnose and prescribe, but unless his advice is followed his work is useless. This important duty is performed by the school nurse. It must be remembered that many public school children are poor children, whose parents are either busy, negligent, impoverished, dissipated or ignorant. They probably have no money with which to purchase medicines, appliances, glasses, medical, surgical and hospital services, etc., and all these things the school 82883-13- 4

nurse undertakes to supply by drawing upon the resources of charitable funds, charitable people, charitable hospitals and charitable doctors. These poor people are sometimes apparently devoid of energy, and have to be cared for with but little confidence in their intelligence. The school nurse then has to secure the medicine and see that it is properly administered. Cleanliness, bathing, properly prepared food, sanitation, ventilation, plumbing and warmth come under her supervision. She takes children to doctor's offices, dispensaries, hospitals, etc., and sees that they get home again. She carries out the doctor's orders at home, such as giving medicines, syringing ears, using eye-drops, making surgical dressings, etc., she cooperates and works with the truant officer in keeping children in school. In short, through her assistance the doctor is able to prescribe or operate with the confident feeling that ... his directions will be followed as far as is humanly possible by the already over-worked school nurse, in cooperation with her equally praiseworthy but overburdened sister, the visiting nurse of the district. Before these commendable institutions came into existence thousands of able operations were virtually thrown to the winds by poor post-operative attendance, and enormous stores of good medical advice nullified by neglect and improper living. The school and visiting nurse have become, then, the element which has transformed doubtful results into reasonably certain good results.

"The school nurse not only comes into contact with the school child, but also naturally and inevitably mingles with the school child's family, and here she performs a most important function, not only to the child, but to the family and to the community as well. By calling upon the family to look after the welfare of the school child, she and the district visiting nurse, if necessary, will endeavor to educate the family to ideas of cleanliness, honesty, sobriety, industry, kindness, cooking, ventilation, infant welfare, etc., in all of which departments of proper living there is abundant opportunity for missionary work among the thickly populated tenement districts of our large cities. This is a department of charity which, unfortunately, will never be overdone, and the extent of its usefulness is only outlined by the amount of money that is eligible for the purpose. I believe there is no charity which furnishes such extensive results for the money subscribed as the visiting and school nurse, and no object for which people may so safely and blindly contribute financial support as the one under consideration; every dollar given helps to make individuals and communities better, healthier and happier."

CARLEY, Margaret E. The school nurse as a link in the chain of preventive medicine. In American school hygiene association. Proceedings, 1912. Springfield [Mass.] American physical education review, 1912. p. 33-40. table. insert. Contains an outline of a plan for the development of school nurses' work, prepared by the writer, Dr. Carley, Department of hygiene, Boston public schools.

CORNELL, Walter Stewart. The nurse as a municipal officer. Psychological clinic, 4: 181-88, December 15, 1910.

Reprinted with some omissions and some new paragraphs and nurses' records in his Health and medical Inspection of school children . . . 1912. p. 82-87. Title: The school nurse.

Article is chiefly the work accomplished in Philadelphia.

"There is no question as to the value and propriety of the nurse's services in treating minor skin diseases of a contagious character. . . .

"It is a fact, however, that the major portion of the nurse's work in the school building has come to be the treatment of minor cuts, bruises, and infections. This relief so freely and so gracefully given

is in reality dispensary work. . . .

"The chief business of the nurse is (a) to shorten or obviate the period of exclusion from school of children suffering from minor contagious diseases, and (b) to secure the correction of physical defects by reason of personal interview with the parents. . A certain proportion of the nurse's work as at present carried on is unnecessary and, therefore, an extravagance. Thousands of bruises and scratches are 'treated' which are so trifling and superficial that the act is a travesty on medicine. . .

"Similarly, the 'treatment' of pediculosis, recorded as almost a third of the nurse's work, is seldom actual treatment at all. It is simply advice. Probably not 1 case in 20 requires a home visit and not 1 case in 50 an actual head scrubbing."

Doctor Cornell says further:

"The results of the school nurse's work are remarkable. Contrasting the work of the medical inspector working without a nurse with that of an inspector working with a nurse, the economy . . . in employing the nurse is easily manifest."

See regarding New York City, p. 76, of the book.

"There are 261 nurses employed in the division of child hygiene of the department of health, [New York City] and there are 55 additional nurses employed for five months during the summer, working from the 1st of May until the 1st of October.

"There are, however, a number of nurses employed in the division of communicable diseases and the division of contagious diseases of this department." (Excerpt from letter, dated Aug. 19, 1912, signed by John J. Cronin, M. D., assistant and acting director of child hygiene, to U. S. Bureau of educa tion, Division of school hygiene)

STEWART, Isabel M. and NUTTING, M. Adelaide. The educational value of the nurse in the public school. In National society for the study of education. Ninth yearbook. Chicago, Illinois, The University of Chicago press [1911] Part 2: 14-60.

Bibliography: p. 72-76.

"There is increasing accumulation of school functions relating to health. These may be cited briefly: "(a) Sanitary inspection of school buildings, systems of ventilation, etc., with special attention to the daily cleaning and the disinfection of schoolrooms and lavatories.

"(b) Medical inspection for detection of contagious diseases and physical defects.

"(c) Personal health examination.

"(d) Hygiene of instruction.

"(e) Emergency service and treatment of minor chronic complaints.

"() Instruction of children in personal, home, and community hygiene and sanitation, and the practical application of the laws of health.

"(g) Instruction of, and cooperation with, parents.

"(h) Physical education."

Historical sketch of school nursing in New York City, and elsewhere, following the London work. In 1903, New York, $30,000 appropriation was made to extend the school nurse service and put it on a definite basis. This provided a staff of 27 nurses at $900 per year. These nurses attended 125 local and 4 parochial schools; since then, the staff has been increased to 141 nurses, including supervisors, all giving their entire time to the work.

Los Angeles was the second city to adopt the system; the work begun by the Visiting nurse society and taken over by the city, 3 nurses being appointed for 80 schools; begun in San Francisco in 1904 by the nurses' settlement, in 1908 was established with staff of 5 nurses. In 1908, Philadelphia Board of Education appointed 6 nurses.

The functions of the school nurse are as follows:

"(a) Assistant to the school doctor in his visits of inspection-preparing children for examination, recording data, testing vision, hearing, etc.

"(b) Routine daily, weekly, or monthly inspection in classrooms.

"(c) Keeping of records, sending out reports to parents, cards to principals, etc.

"(d) Treatment of routine cases in the school-bat hing eyes, irrigating ears, dressing wounds, etc. "(e) Emergency service-caring for accidents, fainting, convulsions, etc.

"Instruction of children in personal hygiene and sanitation-practical demonstrations and talks. "(g) Follow-up work in the homes-notifying physicians, instruction of mothers in the care of children, taking children to dispensaries, dental clinics, etc., for treatment, when necessary.

"(h) Sanitary inspection of homes-discovering and reporting contagious diseases to board of health. "(i) Reporting of truancy cases.

"(j) Teachers' and mothers' meetings.

"(k) Summer work in prevention of infant mortality-playground supervision, fresh-air excursions, etc.

"In no one system are all these functions incorporated. . . . The staff of nurses is usually so entirely inadequate that only the most needy and pressing cases can be attended to. . . .

"The need now is for an institution or organization that will give the preparation required. . . . The one significant attempt to meet this problem is that undertaken by Teachers college at Columbia university, . . . a one-year course under the control of the department of nursing and health. . . . Its distinct aim is to prepare 'teacher nurses.' A high-school certificate, or its equivalent, and a di

ploma from a recognized training school for nurses are required for entrance."

WATERS, Yssabella. Municipalities employing public school nurses. In her Visiting nursing in the United States. . . New York, Charities publication committee, 1909. p. 367 (Table V)

WOOD, Thomas Denison and others. The nurse in education. Chicago, Ill., University of Chicago press [1911] 76 p. 8°. (National society for the study of education. Ninth yearbook. Part 2)

Bibliography: p. 72-76.

See also The educational value of the nurse in the public school, p. 14-60 (Stewart, Isabel M. and Nutting, M. Adelaide) The professional training of children's nurses, p. 61-71 (Read, Mary L.)

IN REPRESENTATIVE CITIES.

BROOKLINE, MASS.

LEWIS, Ida M. [The school nurse system of Brookline, Mass.] In Brookline, Mass. School committee. Report for the year ending December 31, 1910. p. 34-36. A plan for the daily visiting of schools, homes, or dispensaries, establishing the school-nursing sys tem, begun January 4, 1909. Number of eye glasses procured, 49; operations for adenoids and enlarged tonsils, 48; other operations, 5; cases treated at dental infirmaries, 297; number of dressings for relief of impetigo, discharging glands, and wounds, 285.

CHICAGO, ILL.

Chicago. Department of health.

Rules and instructions for school nurses.

"1. The hours for work for nurses are from 8.30 a. m. to 5 p. m. with time off for luncheon. "2. Nurses will visit schools and make routine inspections of hair, eyes, skin, and throats of pupils, and find out from the school inspector's record cards the names and addresses of pupils excluded on account of some contagious disease and those found defective who have been advised to seek treatment. "3. The nurse will refer all cases except pediculosis to the school medical inspector for diagnosis and disposal. A list is to be left for the medical inspector each day.

"4. A failure on the part of the medical inspector to make a diagnosis on his next visit should be reported to the health department.

"5. Treat no case until diagnosis is made.

"6. Emergency treatment as for cuts burns, or skin wounds may be treated once by the nurse if necessary, and the parents then advised to continue treatment, or have the child placed in care of a doctor.

2

"7. Children with marked physical defects, such as those requiring glasses, or suffering from enlarged tonsils, adenoids, or nervous diseases, who have been advised by the medical inspector to seek medical advice, will be visited by the nurse at their homes, and in case treatment has not been begun will advise medical attention. Treatment for favus, scabies, and pediculosis can be advised or administered by the nurse at the home.

"8. Where operation or treatment is indicated and the family not able to pay for treatment, the child's father or mother should go to a free dispensary or hospital with the child. If not possible for them to do so, the nurse can accompany the child if the parents give a written request that she may do so. Nurses may visit homes of those reported absent from school on account of sickness, but must not enter the home if a contagious disease is found."

Instructions for treating minor contagious diseases follow-"provided the parents are not able to employ a doctor or fail to place the child under treatment."

WOODRUFF, Thomas A. The value of the nurse in the public schools. American academy of medicine. Bulletin, 10: 527-33, October, 1909, tables.

Also in American school board journal, 41: 4, 22, November 1910.

In Chicago, where the history of school nursing dates back some eight years, before school nursing was thought of elsewhere in the United States, a small group of workers from the Visiting nurses association were delegated by request of the city school to four special schools. The work grew so rapidly that in the spring of 1908, the nurses found themselves with more than 75 schools on their regular visiting list.

In October, 1908, when the health department of Chicago decided to put on school nurses, the Visiting nurses' association proffered its services. It donated ten of its best nurses to supervise and direct the ten school districts into which the city is divided. It was able to furnish in 48 hours 30 nurses. The school nurses are under the joint supervision of the department of health and the Visiting nurses' association. They are paid by the city. Each has charge of a certain number of schools. She visits these schools each day.

A summary of the benefits derived from work of the school nurse shows

"1. A decrease in the spread of contagion by a close observation of the children... and the supervision of all excluded cases in their homes. 2. They teach the parents, family, and children cleanliness and personal hygiene. 3. They instruct the mother in the care of her children and impress upon her the benefits to be derived from cleanliness, fresh air, and right living. 4. They render more effective the efforts of the medical inspector by visiting the homes of the children and reporting back information of the conditions found there. 5. They frequently find cases of deprivation and disease in the home which would otherwise go undiscovered, and the work of the medical inspector would be of little advantage in the school. 6. They make it possible to treat cases of minor ailments in school."

DETROIT, MICH.

KIEFER, Guy L. The school nurse as an aid to medical inspection of schools. American journal of public hygiene, 20: 279–81, June 1910.

The school-nurse work in Detroit. Two nurses granted in 1909, one added in 1910; each attends four schools daily. During the past year the two nurses made 1,169 visits to the schools and 2,723 home visits. Gave personal attention and such treatment as was possible at the school clinic in 4,651 different instances, and took 158 children to free clinics for treatment. Of the 461 cases of physical defects 289, or a little over 60 per cent, were corrected. Of these 461 cases, 152 had defective eyesight. Of the cases of physical defects not followed up by the nurses, only about 20 per cent received attention.

PHILADELPHIA, PA.

NEWMAYER, S. W. Evidence that the school nurse pays. In American school hygiene association. Proceedings, 1911. Springfield, Mass. American physical education review, 1911, p. 44-51, tables.

Also in New York medical journal, 93: 718-21, April 15, 1911. Reprinted.

Report of the work of the school nurses of Philadelphia for the year ending December 31, 1910.