The Vol. III.
Clinic
Psychological
May 15, 1909.
No. 3.
medical inspection
m THE SAINT PAUL
SCHOOLS* By S. L.
IIeetek,
Superintendent of Schools, Saint Paul,
In
School
study
Minn.
instructions received from the Board of than two years ago, I have made careful of medical inspection in schools as established
compliance witli
Inspectors,
of the
more
subject
and
maintained
and
legislation
is
More than
a
in other cities. I find in this connection one of the most extensive and significant movements in school administration of recent years. More than four hundred towns and cities in the United States report one form or another of medical inspection in their schools. Several states have laws it
Herrmann,
passed
pending
in several other states.
requiring
year ago, I solicited the assistance of Mr. C. J. physical director in the schools of this city, in the
consideration of the following topic: To what extent are school authorities called upon to investigate and meet the physical needs of school children ? The report of Mr. Herrmann's investigations is
given
on
Report.
pages 103-106 of the recent Manual and Biennial
I submit herewith
a series of paragraphs showing the nature inspection in other schools and a brief statement of the findings of such inspection. A physical examination recently conducted in the New York city schools shows that not less than 30 per cent of all the pupils in the elementary schools are suffering from ocular defects alone, demanding correction, and not less than 17 per cent have ocular
of medical
defects so schools.
severe as to
be
a
serious
menace
to their progress in the
*Report submitted to the Board of School Inspectors of Saint Paul, March 31, 1909. The report has since been adopted and the department of medical inspection will be established in September.
Minn.,
(CI)
G2
THE PSYCHOLOGICAL CLINIC. Dr.
Cronin,
chief mcdical
inspector, New
York
City,
in
a
paper read before the School Hygiene Association of America, says that all children reported as backward by various teachers were examined and out of these 95 per cent
were
found
to have
defects. B. F.
that 20 per
Dyer, superintendent
of schools of
physical
Cincinnati,
states
the school children of that city are behind their proper grade in the schools because of defective eyesight, hearing, and other ailments. Dr. Risley examined the eyes of 2422 school children of Philadelphia and found that 44.7 per cent had some deficiency of cent of
vision. Dr. Sexton examined 570 school children of New York City and found that 13.3 per cent had deficient hearing in one or both Of these, only one was known by the teacher to bo defective, only, ten knew themselves to be deficient in this sense. Examinations of 40,000 school children by school physicians the duchy of Saxe-Meiningen, Germany, in 1900, showed that per cent were myopic, 10 per cent or more had spinal curva-
ears.
and in 23
ture and GO per cent
In
a
had teeth which needed attention. medical examination conducted last year in the Franklin
School, Minneapolis, the following results were found: Malnutrition, 115; enlarged cervical glands, 170; St. Vitus dance, 1; cardiac diseases, 9 ; pulmonary diseases, 5 ; defective spine 4; defective palate, 1; enlarged tonsils, 112; post nasal growths, 4G; pediculosis, 18; trachoma, 2; conjunctivitis, 2; blepharitis, 14; scabies, 2; acute coryza, 8; bronchitis, 15; enlarged thyroid, 2; epilepsy, 1. By school inspection it is discovered that of more than 400,000 children examined in the schools of Massachusetts, 81,000 are defective in vision and 22,000 in hearing; it is stated on reliable 90 per cent of the school children of
Germany have defective teeth and examination shows the same proportion in American towns and cities; 137 cases of excessivo adenoid growths are reported for a single city; whole schools have been found authority that
infected with head-lice. While no medical examination of school children has ever been undertaken in this city it is probably safe to assume that the defective pupils is not much, if any, percentage of physically, smaller than that found in the above mentioned cities. I recently sent to all the schools, carefully prepared tables calling for tabulated reports from principals on the ages and grades of pupils These reports indicate that 12,G72 cliilin the various schools.
MEDICAL INSPECTION.
63
dren in the Saint Paul grade schools or 56 per cent of the average enrolment are one year or more behind their grades. Of these 6328
are one
year
behind;
3650 two years; 1689 three years; 651
four years; 221 five years; and 133 six years or more behind their grades. To my mind here is a serious situation inviting the
investigation of the school authorities city. There are evidently many causes for this phenomenal retardation, such as late entrance, foreign birth, ignorance of the English language, irregular attendance, failures in promotion, congested courses of study, over-emphasis of intellectual subjects, etc., and yet it seems likely that one of the largest factors entering into earnest consideration and
of this
children is physiological, and that more attention given in our schools to the bodily conditions of children will throw new light on our educational problems, and even on the of backward children, and of deliquency itself. this backwardness of
our
subject
It appears that the schools have been too exclusively concerned about the minds of children and too little concerned about their bodies. Much time and energy and money have been wasted in mental power, without in to make all children
equal
trying
regard
ging
to
our
physical inequalities,
until
now waste
products
aie
clog-
educational machinery.
mental and even Physical degeneracy too frequently leads to moral degeneracy and the school of the future must be moie concerned about its under-fed and pale-faced dullards; its oxygen-
starved mouth-breathers, and its flat-chested anaBmics, and so fai as possible aim to increase the working efficiency of pupils by the discovery and the correction of the fundamental physical defects which bear directly upon their work in the schools. I am convinced, therefore, in the light of such consideiaexamination and inspection of children tions, that the
physical
not only in the elementary schools is a matter of vital importance to the individual child and the home but to the school system itself, and that the Board of School Inspectors of Saint Paul can do more in building up a rational, economic, and efficient system ?f well-being of the for its basis the
education, having
individual child.
physical
and just here that the schools need the expert advice is counsel, and the periodical visits of a school physician, who employed to spend this time in the schools. In reaching this conclusion, and in making the recommendations that follow, I am not unmindful of the effective work that has been done for a number of years, and is still being done in the It is
64
THE PSYCHOLOGICAL CLINIC.
schools by the Department of Health. But medical inspection in the schools should contemplate far more than the discovery and control of infectious and contagious diseases. Oversight of such diseases should remain fundamentally, the duty of the board of
health, and all matters relating to the means of detecting communidiseases, and the means of combating their spread should continue to be regulated according to the rules and laws established by that body. Medical inspection should be established and maintained by the board of education, however, for the purpose of bringing to the knowledge of teachers and parents the physical defects of cable
individual children which stand in the way of
health,
and defeat
the mental progress.
Medical inspection should be considered in the light of an educational problem, rather than a medical problem pure and simple. It should involve the following of the child from grade to grade, the constant attention of the teacher to all of the school work and the conduct of the child. Medical inspection should be dealt with not by physicians only. Its work should be under the control of the board of education and immediately under the direction of the superintendent The medical inspector should appreciate the relation of schools. to the work of the teacher. work -his of lie should, in fact, be an educator as a physician. lie should consider himas much of self a part of the school corps, not merely to discover and report physical ailments, which affect the health of children; but to increase the physical and mental capacity of pupils, to add to the happiness of their lives, to render instruction more effective, and to increase the efficiency of the school system. I therefore recommend that a department of medical inspection be created and maintained in Saint Paul under the rules and regulations herewith submitted. inspector of the schools shall be appointed each year at the annual meeting of the board in June. He shall be elected to his salary shall be fixed in accordserve for the school year only and 1. A medical
with the high-school teachers' schedule. No one shall bo deemed eligible to this appointment except he be a graduate of a recognized medical college and hold a license from the State Board of Medical Examiners of the state of Minnesota. 2. The medical inspector of schools shall give his entire time to the work of this department from 8:30 a. m. to 12 m. on school days, lie shall not engage in any other practice during the above stated hours. ance
MEDICAL INSPECTION.
65
3. At the beginning of each school week, he shall transmit to the superintendent of schools a program of visits to be made by him during the week, and shall do his work under the direction of the superintendent of schools and in compliance with the rules and regulations of the Board of School Inspectors. 4. He shall keep office hours at the offices of the Board of School Inspectors on not less than three school days of each week, from 4 to
for free consultation with principals, teachers and parents. inspector shall have charge of the examination and inspection of children, aiming essentially to report to the teachers and parents physical conditions on the part of children which affect their health, and retard mental or moral progress. He shall cooperate with the Health Department of the city in the discovery of communicable diseases in their incipiency, and in bringing about prompt isolation of from contagious infectious diseases, and in securing pupils
5:30
p. m.,
5. The medical
suffering
the prompt return of such pupils upon recovery. G. Within the first semester of each school year he shall make a thorough physical examination of all pupils in the elementary schools as he reported to him by the teachers and principals and such others semester second the may suspect of having physical ailments. Within he shall make a sccond examination of all pupils found physically de-
fective in the first, and such as may be recommended for special examination by the teachers and principals. T. Card records shall be made by the medical inspector of all children affected with physical ailments or diseases needing treatment, and
to parents records shall be made and forwarded as a report to the deems medical the inspector as such recommendations carrying interest of the child. treat8. The medical inspector shall not be permitted to give any of cases in emergency, ment to children except temporary assistance or
duplicate
shall he recommend to parents, except upon request, any physician, dentist, oculist, or specialist for treatment of any case. 9. The medical inspector shall be assisted in his work by a school school nurse who shall be employed to give her entire time during the with year to the schools and whose salary shall be fixed in accordance the grade teachers' schedule. It shall be the duty of the school nurse to accompany the medical inspector of schools and assist in the physical examination of the pupils, to assist the inspector in recording health defects and in to follow up cases reported to the nor
reporting
to
parents,
in the judgment may be deemed necessary of the medical inspector. 10. The medical inspector shall also send notice to the parents or
homes;
to visit such homes
as
guardians of pupils lacking in cleanliness, or needing treatment; he shall be authorized to exclude from school any pupil for physical defects and diseases until such time as, in his judgment, the pupil can
60
THE.PSYCHOLOGICAL CLINIC.
be safely reinstated. He sliall see that principals and teachers do not permit the return to school of pupils from quarantine without the proper certificate from the Department of Health. 11. He shall meet the principals, as well as the teachers of each grade at least once each semester and give such instruction to principals and teachers as will make them familiar with the more conspicuous symptoms of physical and mental deficiency, to the end that they may suggest only those who are really atypical to the inspector for examination. Ho shall give instruction to teachers respecting vision and hearing tests, and on such matters relating to the physical inspection of children as will promise the assistance and cooperation of teachers and principals in the work of his department. 12. The medical inspector shall make recommendations, when requested by the superintendent of buildings or by the board, on matters respecting the phvsical environment of school children, such as the building lot, the drainage, heating, plumbing, ventilating, water supply, drinking facilities, sweeping, scrubbing, use of disinfectants, deodorizing, fumigating, etc. 13. He shall report regularly to the superintendent of buildings the necessity of change in the seating in any building or room to meet the physical needs of a class or of individual pupils.
Clinic
Psychological
May 15, 1909.
No. 3.
medical inspection
m THE SAINT PAUL
SCHOOLS* By S. L.
IIeetek,
Superintendent of Schools, Saint Paul,
In
School
study
Minn.
instructions received from the Board of than two years ago, I have made careful of medical inspection in schools as established
compliance witli
Inspectors,
of the
more
subject
and
maintained
and
legislation
is
More than
a
in other cities. I find in this connection one of the most extensive and significant movements in school administration of recent years. More than four hundred towns and cities in the United States report one form or another of medical inspection in their schools. Several states have laws it
Herrmann,
passed
pending
in several other states.
requiring
year ago, I solicited the assistance of Mr. C. J. physical director in the schools of this city, in the
consideration of the following topic: To what extent are school authorities called upon to investigate and meet the physical needs of school children ? The report of Mr. Herrmann's investigations is
given
on
Report.
pages 103-106 of the recent Manual and Biennial
I submit herewith
a series of paragraphs showing the nature inspection in other schools and a brief statement of the findings of such inspection. A physical examination recently conducted in the New York city schools shows that not less than 30 per cent of all the pupils in the elementary schools are suffering from ocular defects alone, demanding correction, and not less than 17 per cent have ocular
of medical
defects so schools.
severe as to
be
a
serious
menace
to their progress in the
*Report submitted to the Board of School Inspectors of Saint Paul, March 31, 1909. The report has since been adopted and the department of medical inspection will be established in September.
Minn.,
(CI)
G2
THE PSYCHOLOGICAL CLINIC. Dr.
Cronin,
chief mcdical
inspector, New
York
City,
in
a
paper read before the School Hygiene Association of America, says that all children reported as backward by various teachers were examined and out of these 95 per cent
were
found
to have
defects. B. F.
that 20 per
Dyer, superintendent
of schools of
physical
Cincinnati,
states
the school children of that city are behind their proper grade in the schools because of defective eyesight, hearing, and other ailments. Dr. Risley examined the eyes of 2422 school children of Philadelphia and found that 44.7 per cent had some deficiency of cent of
vision. Dr. Sexton examined 570 school children of New York City and found that 13.3 per cent had deficient hearing in one or both Of these, only one was known by the teacher to bo defective, only, ten knew themselves to be deficient in this sense. Examinations of 40,000 school children by school physicians the duchy of Saxe-Meiningen, Germany, in 1900, showed that per cent were myopic, 10 per cent or more had spinal curva-
ears.
and in 23
ture and GO per cent
In
a
had teeth which needed attention. medical examination conducted last year in the Franklin
School, Minneapolis, the following results were found: Malnutrition, 115; enlarged cervical glands, 170; St. Vitus dance, 1; cardiac diseases, 9 ; pulmonary diseases, 5 ; defective spine 4; defective palate, 1; enlarged tonsils, 112; post nasal growths, 4G; pediculosis, 18; trachoma, 2; conjunctivitis, 2; blepharitis, 14; scabies, 2; acute coryza, 8; bronchitis, 15; enlarged thyroid, 2; epilepsy, 1. By school inspection it is discovered that of more than 400,000 children examined in the schools of Massachusetts, 81,000 are defective in vision and 22,000 in hearing; it is stated on reliable 90 per cent of the school children of
Germany have defective teeth and examination shows the same proportion in American towns and cities; 137 cases of excessivo adenoid growths are reported for a single city; whole schools have been found authority that
infected with head-lice. While no medical examination of school children has ever been undertaken in this city it is probably safe to assume that the defective pupils is not much, if any, percentage of physically, smaller than that found in the above mentioned cities. I recently sent to all the schools, carefully prepared tables calling for tabulated reports from principals on the ages and grades of pupils These reports indicate that 12,G72 cliilin the various schools.
MEDICAL INSPECTION.
63
dren in the Saint Paul grade schools or 56 per cent of the average enrolment are one year or more behind their grades. Of these 6328
are one
year
behind;
3650 two years; 1689 three years; 651
four years; 221 five years; and 133 six years or more behind their grades. To my mind here is a serious situation inviting the
investigation of the school authorities city. There are evidently many causes for this phenomenal retardation, such as late entrance, foreign birth, ignorance of the English language, irregular attendance, failures in promotion, congested courses of study, over-emphasis of intellectual subjects, etc., and yet it seems likely that one of the largest factors entering into earnest consideration and
of this
children is physiological, and that more attention given in our schools to the bodily conditions of children will throw new light on our educational problems, and even on the of backward children, and of deliquency itself. this backwardness of
our
subject
It appears that the schools have been too exclusively concerned about the minds of children and too little concerned about their bodies. Much time and energy and money have been wasted in mental power, without in to make all children
equal
trying
regard
ging
to
our
physical inequalities,
until
now waste
products
aie
clog-
educational machinery.
mental and even Physical degeneracy too frequently leads to moral degeneracy and the school of the future must be moie concerned about its under-fed and pale-faced dullards; its oxygen-
starved mouth-breathers, and its flat-chested anaBmics, and so fai as possible aim to increase the working efficiency of pupils by the discovery and the correction of the fundamental physical defects which bear directly upon their work in the schools. I am convinced, therefore, in the light of such consideiaexamination and inspection of children tions, that the
physical
not only in the elementary schools is a matter of vital importance to the individual child and the home but to the school system itself, and that the Board of School Inspectors of Saint Paul can do more in building up a rational, economic, and efficient system ?f well-being of the for its basis the
education, having
individual child.
physical
and just here that the schools need the expert advice is counsel, and the periodical visits of a school physician, who employed to spend this time in the schools. In reaching this conclusion, and in making the recommendations that follow, I am not unmindful of the effective work that has been done for a number of years, and is still being done in the It is
64
THE PSYCHOLOGICAL CLINIC.
schools by the Department of Health. But medical inspection in the schools should contemplate far more than the discovery and control of infectious and contagious diseases. Oversight of such diseases should remain fundamentally, the duty of the board of
health, and all matters relating to the means of detecting communidiseases, and the means of combating their spread should continue to be regulated according to the rules and laws established by that body. Medical inspection should be established and maintained by the board of education, however, for the purpose of bringing to the knowledge of teachers and parents the physical defects of cable
individual children which stand in the way of
health,
and defeat
the mental progress.
Medical inspection should be considered in the light of an educational problem, rather than a medical problem pure and simple. It should involve the following of the child from grade to grade, the constant attention of the teacher to all of the school work and the conduct of the child. Medical inspection should be dealt with not by physicians only. Its work should be under the control of the board of education and immediately under the direction of the superintendent The medical inspector should appreciate the relation of schools. to the work of the teacher. work -his of lie should, in fact, be an educator as a physician. lie should consider himas much of self a part of the school corps, not merely to discover and report physical ailments, which affect the health of children; but to increase the physical and mental capacity of pupils, to add to the happiness of their lives, to render instruction more effective, and to increase the efficiency of the school system. I therefore recommend that a department of medical inspection be created and maintained in Saint Paul under the rules and regulations herewith submitted. inspector of the schools shall be appointed each year at the annual meeting of the board in June. He shall be elected to his salary shall be fixed in accordserve for the school year only and 1. A medical
with the high-school teachers' schedule. No one shall bo deemed eligible to this appointment except he be a graduate of a recognized medical college and hold a license from the State Board of Medical Examiners of the state of Minnesota. 2. The medical inspector of schools shall give his entire time to the work of this department from 8:30 a. m. to 12 m. on school days, lie shall not engage in any other practice during the above stated hours. ance
MEDICAL INSPECTION.
65
3. At the beginning of each school week, he shall transmit to the superintendent of schools a program of visits to be made by him during the week, and shall do his work under the direction of the superintendent of schools and in compliance with the rules and regulations of the Board of School Inspectors. 4. He shall keep office hours at the offices of the Board of School Inspectors on not less than three school days of each week, from 4 to
for free consultation with principals, teachers and parents. inspector shall have charge of the examination and inspection of children, aiming essentially to report to the teachers and parents physical conditions on the part of children which affect their health, and retard mental or moral progress. He shall cooperate with the Health Department of the city in the discovery of communicable diseases in their incipiency, and in bringing about prompt isolation of from contagious infectious diseases, and in securing pupils
5:30
p. m.,
5. The medical
suffering
the prompt return of such pupils upon recovery. G. Within the first semester of each school year he shall make a thorough physical examination of all pupils in the elementary schools as he reported to him by the teachers and principals and such others semester second the may suspect of having physical ailments. Within he shall make a sccond examination of all pupils found physically de-
fective in the first, and such as may be recommended for special examination by the teachers and principals. T. Card records shall be made by the medical inspector of all children affected with physical ailments or diseases needing treatment, and
to parents records shall be made and forwarded as a report to the deems medical the inspector as such recommendations carrying interest of the child. treat8. The medical inspector shall not be permitted to give any of cases in emergency, ment to children except temporary assistance or
duplicate
shall he recommend to parents, except upon request, any physician, dentist, oculist, or specialist for treatment of any case. 9. The medical inspector shall be assisted in his work by a school school nurse who shall be employed to give her entire time during the with year to the schools and whose salary shall be fixed in accordance the grade teachers' schedule. It shall be the duty of the school nurse to accompany the medical inspector of schools and assist in the physical examination of the pupils, to assist the inspector in recording health defects and in to follow up cases reported to the nor
reporting
to
parents,
in the judgment may be deemed necessary of the medical inspector. 10. The medical inspector shall also send notice to the parents or
homes;
to visit such homes
as
guardians of pupils lacking in cleanliness, or needing treatment; he shall be authorized to exclude from school any pupil for physical defects and diseases until such time as, in his judgment, the pupil can
60
THE.PSYCHOLOGICAL CLINIC.
be safely reinstated. He sliall see that principals and teachers do not permit the return to school of pupils from quarantine without the proper certificate from the Department of Health. 11. He shall meet the principals, as well as the teachers of each grade at least once each semester and give such instruction to principals and teachers as will make them familiar with the more conspicuous symptoms of physical and mental deficiency, to the end that they may suggest only those who are really atypical to the inspector for examination. Ho shall give instruction to teachers respecting vision and hearing tests, and on such matters relating to the physical inspection of children as will promise the assistance and cooperation of teachers and principals in the work of his department. 12. The medical inspector shall make recommendations, when requested by the superintendent of buildings or by the board, on matters respecting the phvsical environment of school children, such as the building lot, the drainage, heating, plumbing, ventilating, water supply, drinking facilities, sweeping, scrubbing, use of disinfectants, deodorizing, fumigating, etc. 13. He shall report regularly to the superintendent of buildings the necessity of change in the seating in any building or room to meet the physical needs of a class or of individual pupils.
