;,|i!:|H iii Glass L' B M U Book ^^P.^^^^ L i lb iiiiil I! I TREASURY DEPARTMENT UNITED STATES PUBLIC HEALTH SERVICE RUPERT BLUE, SURGEON General SCHOOL MEDICAL INSPECTION BY TALIAFERRO CLARK Assistant Surgeon General United States Public Health Service REPRINT No. 554 FROM THE PUBLIC HEALTH REPORTS Septembee 5; 1313 (Pages 2613-2018) H-':7t.fo^ WASHINGTON GOVERNMENT PRINTING OFFICE] 1919 tiilon ogr&pt /^^.^ ADDITIONAL COPIES OF THIS PUBLICATION MAT BE PEOCUEED FROM THE SUPERINTENDENT OF DOCUMENTS GOVERNMENT PRINTING OFFICE WASHINGTON, D. C. AT 6 CENTS PEE, COPY 0^ of J. NOV 2S 0> SCHOOL MEDICAL INSPECTION.^ By Tali.u?eeko Clark, Assistant Surgeon General, United States Public Health Service. With tlie time for the opening of the schools drawing near it is very desirable that communities, and especially the responsible officials, should take stock of resources for the health sujDervision of school children. Owing to inevitable adjustments that are now taking place in the national life a"S a result of the war, and especially in view of the changed economic conditions, the increased cost of the necessities of life, and the strong appeal of greater remunera- tion m other fields to those engaged in health activities, the impor- tance of adequate health supervision of the children of the land is emphasized as never before in the history of our country. The Advantage of Health Supervision of School Cliildren. The health of the growing child determines largely the health and bodily vigor of the grown man. The community, therefore, can take no more important step to insure the future efficiency of its citizens than that of growing healthy children. In the present state of society an intelligent supervision of the health of the children during the period of school life is probably one of the most potent measures for this purpose and is recognized as such by law in an increasing number of the States of the Union. This is especially true since in but a very few fortunate communities is any attention whatsoever given to general health supervision of childi^en during the impres- sionable preschool age covering the period from 2 to 5 years of age, inclusive. Intensive studies of the physical conditions of children in many places have shown large numbers of them to have physical defects which were previously unrecognized and unsuspected. Many of the defects thus shown are preventable and -remediable. Their persistence results not only in reduced individual efficiency, but also, in the aggregate, in reduced national efficiency, as is so clearly shown by the high percentage of those found unfit for military service in the physical examinations conducted under the Selective-service law. The conditions under which children assemble in school, and not the school itself, are largely responsible for much of the sickness contracted during the period of school life and for the persistence 1 Reprint from the Public Health Reports, vol. 34, No. 36, Sept. 5, 1919, pp. 2013-2018. 139880°— 19 3 4 SCHOOL MEDICAL INSPECTION. of physical defects. The control of adverse causes during this period not only exercises an immediate beneficial effect on the health of the children, but serves m.ost effectively to teach them the principles of personal hygiene, the nonobservance of which is now believed to be mainly responsible for the large annual increase in the number of deaths from degenerative diseases that occur later in life. Experience shows that the failure to prevent and correct impair- ment of hearing and vision and to detect abnormalities of color perception, to secure dental attention, to alleviate postural defects, to place the normal child in an environment best suited for physical development, greatly restricts the range of industrial, business, and professional opportunity in adult life. Moreover, a number of defective children are unable to take full advantage of their educa- tional opportunity. They fall behind in school work, become dis- couraged because unable to keep pace with normal children in theu' classes, and ultimately quit school poorly prepared for useful citizen- ship. It is of prime importance to the community, therefore, to take cognizance of these possibilities in order that steps may be taken to prevent them. Furthermore, the control of the communicable diseases in the community can be accomplished more effectively when undertaken in connection with the medical inspection of school children. Altogether, the loss of life, the impairment of hearing and vision, the tendency to degenerative diseases caused by neglect of personal hygiene, and the loss of time in school work render it highly desirable from the economic standpoint alone to inaugurate a measure so potential in the control of the communicable diseases. A Desirable System of Health Supervision of School Cliildren An effective system of health supervision of school children should provide (1) for the thorough sanitation of all buildings used for school purposes; (2) for the intelligent supervision of classrooms to detect and correct conditions injurious to the health of the pupils as soon as they arise; (3) for the full-time services of medical inspectors qualified to discharge the sanitary and medical duties of the school ph5'sicians, (4) for the full-time services of school nurses; (5) for facilities for dental inspections; (6) provision whereby necessitous cliildren may receive free treatment best suited to their needs; and (7) for a thorough mental examination of all children who fail to progress normally in schoolwork. Objections have been made to health supervision of school children and the treatment of their physical defects on the ground that such measures discriminate against the regular practice of medicine, encourage pauperism in parents, raise the tax rate, and tend to bring about a lowered sense of responsibility on the part of parents in respect of the health of their children. The experience of countries and communities wherein these measures are in full force SCHOOL MEDICAL INSPECTIOIiT. 5 does not substantiate these claims. It has been found that the more regular attendance of children at school brought about by competent health supervision, and the educational effect on parents of such measures when applied to their children, reflect in time so advan- tageously on the community as to more than compensate for the expenditures involved in such supervision. Scope of Medical Inspection. The demands of a reasonable medical inspection of school children are met by the following observances : (1) To examine for the presence of physical or mental defects which make it inadvisable for certain children to attend school; (2) to measure and weigh all children to determine the average physical development by sex and one-year age periods, and the utilization of such standards as an index of nutrition and as a guide to the discovery of harmful causes in the case of children who do not develop normally; (3) to discover, re- move, and prevent defects of dentition, hearing, posture, and vision that hamper children in schoolwork and retard their physical and mental development; (4) to aid the health authorities in the control of communicable diseases. Requirements of a Scliool Medical Inspector. The minimum requirements of an acceptable school physician are: (1) That he should devote his full time to the supervision of the health of school children; (2) that he should be skilled in medical diagnosis, able to advise with and assist the family physician when it is so desired; (3) that he should have a knowledge of bacteriology sufficient to enable him to take cultures, detect "carriers," and other- wise assist the health authorities so that it may be unnecessary to close schools during epidemics of communicable diseases; (4) that he should be well grounded in the principles of personal and general hy- giene and, have the ability to apply them to school purposes; (5) that he should be competent to prescribe suitable exercises in individual cases to overcome postural defects, and advise with regard to regulated group exercises designed co promote the best physicfil development of normal children; (6) and that he should notify all parents of the presence of physical defects in their children as soon as these defects are discovered and make reasonable efforts to have liis recommenda- tions carried out. In the selection of a school physician due regard should be given to his ability to direct the seating of children, to make observation of atmospheric conditions in classrooms, to measure illumination and to advise in regard to changes necessary to secure the maximum of illumination with the minimum of visual discomfort, and finally to advise janitors in respect of the heating and ventilation of school buildings. SCHOOL MEDIC.YL IXSPECTIOF. Tlie notification blank to parent or guardian may be arranged as follows : Office Medical Inspector of Schools. Parent or guai'dian. A recent iphj^sical inspection of Address. Name of cliild. indicates the following abnormal conditions: Name of school. to your family phj-sician, dentist, oculist, Name of child. or to a dispensary for advice and treatment. Medic ^1 inspector. In every case where the child is excluded from school on account of sickness or disability, the medical inspector should be required to notify, in writing, the parent or guardian, specifying the cause of such exclusion and stating explicitly the terms under which the child may return to school. o Syracuse, N. Y. ,?; > PAT. JAN. 21, 1908 ■-^"