Health Work in the Public Schools.

by Leonard P. Ayres and May Ayres.

FOREWORD

This report on "Health Work in the Public Schools" is one of the 25 sections of the report of the Educational Survey of Cleveland conducted by the Survey Committee of the Cleveland Foundation in 1915.

Twenty-three of these sections will be published as separate monographs. In addition there will be a larger volume giving a summary of the findings and recommendations relating to the regular work of the public schools, and a second similar volume giving the summary of those sections relating to industrial education. Copies of all these publications may be obtained from the Cleveland Foundation. They may also be obtained from the Division of Education of the Russell Sage Foundation, New York City. A complete list will be found in the back of this volume, together with prices.

HEALTH WORK IN THE PUBLIC SCHOOLS

Cleveland employs 16 physicians, one oculist, and 27 nurses to take charge of the health of her school children. The city spends $36,000 a year on salaries and supplies for these people. There are 86 school dispensaries and clinics. Cleveland is making this heavy investment because she finds it pays.

THE ARGUMENT FOR MEDICAL INSPECTION

Medical inspection is an extension of the activities of the school in which the educator and the physician join hands to insure for each child such conditions of health and vitality as will best enable him to take full advantage of the free education offered by the state. Its object is to better health conditions among school children, safeguard them from disease, and render them healthier, happier, and more vigorous. It is founded upon a recognition of the intimate relationship between the physical and mental conditions of the children, and the consequent dependence of education on health conditions.

In Cleveland, the value of medical inspection was recognized while the movement was still in its infancy in America. Here, as elsewhere, this sudden recognition of the imperative necessity for safeguarding the physical welfare of school children grew out of the discovery that compulsory education under modern city conditions meant compulsory disease.

The state, to provide for its own protection, has decreed that all children must attend school, and has put in motion the all-powerful but indiscriminating agency of compulsory education, which gathers in the rich and the poor, the bright and the dull, the healthy and the sick. The object was to insure that these children should have sound minds. One of the unforeseen results was to insure that they should have unsound bodies. Medical inspection is the device created to remedy this condition. Its object is prevention and cure.

Ever since its establishment the good results of medical inspection have been evident. Epidemics have been checked or avoided.

Improvements have been noted in the cleanliness and neatness of the children. Teachers and parents have come to know that under the new system it is safe for children to continue in school in times of threatened or actual epidemic.

HEALTH AND SCHOOL PROGRESS

But medical inspection does not confine itself to dealing with contagious disease. Its aid has been invoked to help the child who is backward in his school studies. With the recent extensions in the length of the school term and the increase in the number of years of schooling demanded of the child, has come a great advance in the standards of the work required. When the standards were low, the work was not beyond the capacity of even the weaker children; but with close grading, fuller courses, higher standards, and constantly more insistent demands for intellectual attainment, conditions have changed. Pupils have been unable to keep up with their cla.s.ses. The terms "backward," "r.e.t.a.r.ded," and "exceptional," as applied to school children, have been added to the vocabularies of educators.

School men discovered that the drag-net of compulsory education was bringing into school hundreds of children who were unable to keep step with their companions, and because this interfered with the orderly administration of the school system, they began to ask why the children were backward.

The school physicians helped to find the answer when they showed that hundreds of these children were backward simply because of removable physical defects. And then came the next great forward step, the realization that children are not dullards through the will of an inscrutable Providence, but rather through the law of cause and effect.

EXAMINATIONS FOR PHYSICAL DEFECTS

This led to an extension of the scope of medical inspection to include the physical examination of school children with the aim of discovering whether or not they were suffering from such defects as would handicap their educational progress and prevent them from receiving the full benefit of the free education furnished by the state. This work was in its infancy five years ago, but today Cleveland has a thorough and comprehensive system of physical examination of its school children.

Surprising numbers of children have been found who, through defective eyesight, have been seriously handicapped in their school work. Many are found to have defective hearing. Other conditions are found which have a great and formerly unrecognized influence on the welfare, happiness, and mental vigor of the child. Attention has been directed to the real significance of adenoids and enlarged tonsils, of swollen glands and carious teeth.

Teachers and parents have come to realize that the problem of the pupil with defective eyesight may be quite as important to the community as that of the pupil who has some contagious disease. If a child who is unable to see distinctly is placed in a school where physical defects are unrecognized and disregarded, headaches, eyestrain, and failure follow all his efforts at study. He cannot see the blackboards and charts; printed books are indistinct or are seen only with much effort, everything is blurred. Neither he nor his teacher knows what is the matter, but he soon finds it impossible to keep pace with his companions, and, becoming discouraged, he falls behind in the unequal race.

In no better plight is the child suffering from enlarged tonsils and adenoids, which prevent proper nasal breathing and compel him to keep his mouth open in order to breathe. Perhaps one of his troubles is deafness. He is soon considered stupid. This impression is strengthened by his poor progress in school. Through no fault of his own he is doomed to failure. He neglects his studies, hates his school, leaves long before he has completed the course, and is well started on the road to an inefficient and despondent life.

Public schools are a public trust. When the parent delivers his child to their care he has a right to insist that the child under the supervision of the school authorities shall be safe from harm and shall be handed back to him in at least as good condition as when it entered school. Even if the parent does not insist upon it, the child himself has a right to claim protection. The child has a claim upon the state and the state a claim upon the child which demands recognition. Education without health is useless. It would be better to sacrifice the education if, in order to attain it, the child must lay down his good health as a price. Education must comprehend the whole man and the whole man is built fundamentally on what he is physically.

OBJECTIONS TO MEDICAL INSPECTION

The objection that the school has no right to permit or require medical inspection of the children will not bear close scrutiny or logical a.n.a.lysis. The authority which has the right to compel attendance at school has the added duty of insisting that no harm shall come to those who go there. The exercise of the power to enforce school attendance is dangerous if it is not accompanied by an appreciation of the duty of seeing to it that the a.s.sembling of pupils brings to the individual no physical detriment.

[Ill.u.s.tration: Tony's tonsils need attention.]

Nor are the schools, in a.s.suming the medical oversight of the pupils, trespa.s.sing upon the domain of private rights and initiative. Under medical inspection, what is done for the parent is to tell him of the needs of his child, of which he might otherwise have been in ignorance. It leaves to the parent the duty of meeting those needs. It leaves him with a larger responsibility than before. It is difficult to find a logical basis for the argument that the school has not the right to inform the parents of defects present in the child, and to advise as to remedial measures which should be taken to remove them.

The justification of the state in a.s.suming the function of education and in making that education compulsory is to insure its own preservation and efficiency. Whether or not it is successful will depend on the degree to which its individual members are spiritually prepared for modern co-operation.

But the well-being of a state is as much dependent upon the strength, health, and productive capacity of its members as it is upon their knowledge and intelligence. In order that it may insure the efficiency of its citizens, the state, through its compulsory education enactments, requires its youth to pursue certain studies which experience has proved necessary to secure that efficiency. Individual efficiency, however, rests not alone on education or intelligence, but is equally dependent on physical health and vigor. Hence, if the state may make mandatory training in intelligence, it may also command training to secure physical soundness and capacity. Health is the foundation on which rests the happiness of a people and the power of a nation.

HOW THE WORK STARTED

The first work of this kind in Cleveland is described in Superintendent Jones' report for 1900. In that year the schools became greatly interested in the question of defective vision. Tests were made by teachers in different grades, and as a result over 2,000 children were given treatment.

In 1906, an agreement was reached with the Board of Health, so that each alternate day a health inspector communicated with the princ.i.p.al of every school. Teachers were warned to be on the alert for symptoms of illness, and children showing signs of measles, whooping cough, scarlet fever, or other common diseases of childhood, were reported to the princ.i.p.al, and through her to the Board of Health. Contagious cases were excluded from school as soon as detected, and a systematic campaign started against the waves of disease which were sweeping one after another through the schools.

In the same year Drs. L. W. Childs, J. H. McHenry, H. L. Sanford, and other members of the medical profession volunteered their services as school physicians, to detect not only cases of possible contagion, but also the existence of physical defects. What was probably the first school dispensary in the United States was opened at the request of Dr. Childs by the Board of Education in 1907 at the Murray Hill School. The value of school dispensaries was so immediately evident that by 1909 seven others were established for the use of these three physicians.

Coincident with the dispensaries came the school nurse. When the first nurse was appointed at the Murray Hill School, a remarkable change was observed among the children. Absences became less frequent. Skin diseases were rare. Children began to take an interest in health matters, and there was a marked rise in standards of neatness and cleanliness. Teachers and princ.i.p.als united in their demand for more nurses, until within a year after the movement started there were six nurses appointed by the Board of Education and regularly employed in school work. In the same year, December, 1909, the Board of Education formally voted to establish a Division of Health Supervision and Inspection as part of the regular school system.

THE PRESENT SYSTEM

As it is at present organized, the Division handles inspection for contagious disease, inspection for physical and mental defects, follow-up work for the remedying of defects, health instruction, recommendation of children to schools for the physically and mentally handicapped, school lunches, gardens, and playgrounds.

Either the nurse or physician reports at each school every day of the year. Once during the year each child is given a careful physical examination, and further examinations are made when they are needed.