III. COUNTY MACHINERY 1. Clearing house for facts regarding school hygiene taught and practiced in all schools within county limits; this to be maintained by the county superintendent of schools. 2. Physician and nurse to organize inspection and instruction for rural schools, to give lessons and make demonstrations at county institutes, to show teachers how to interest physicians, dentists, health officers, and parents in the physical welfare of school children. IV. TOWN AND TOWNSHIP MACHINERY 1. Teachers intelligent as to physical needs, as to sanitation of buildings, etc. 2. An examining physician, to be salaried where the population justifies; elsewhere to work as a volunteer in coöperation with teacher and with county physician. 3. Physical history of each child from date of entrance to date of leaving school, to be kept up to date by teacher. V. CITY MACHINERY I. A division to be known as the Department of School Hygiene, headed by an officer who gives his entire time to that department. 2. A subcommittee of the Board of Education. 3. Clearing house for facts regarding school hygiene taught and practiced in all schools within city limits. 4. Specialists to examine applicants for teaching positions, and to reëxamine teachers to determine fitness for continuance, for promotion, and for special assignments. 5. A bureau for inspection and control of all hygiene of school buildings, old and new, with power to compel repairs or to reject plans that do not make adequate sanitary provision. 6. Similar supervision of curriculum and of study hours prescribed. 7. A bureau for the inspection and control of curriculum, required home study, exercise, physical training, etc., so far as relates to the health of pupils, and to the physical ability of children to be in certain grades or to be promoted. This will decide the duration of lessons, frequency of intermissions, sequence of subjects, time and method of recess throughout the various grades. 8. Supervision of indoor and outdoor playgrounds, roof gardens, indoor and outdoor gymnasiums, swimming pools, etc. 9. Supervision of instruction in school hygiene. 10. A staff of inspectors for communicable diseases of pupils and teachers, to be subject to the board of education or the board of health. 11. A staff of examiners adequate to examine all children and teachers at least once a year for defects of eye, ear, teeth, nose, throat, lungs, spine, bones, glands, etc., and for weight and height to be under the control of the board of education or the board of health. The expense would not be as great as the penalty paid for omitting such examination. 12. A staff of nurses to assist medical examiners to give children practical demonstrations in cleanliness, to teach mothers the care of children both at their homes and in mothers' meetings, to enlist the coöperation of family physician and neighborhood facilities, such as hospitals, dispensaries and relief agencies, magistrates' courts and probation officers, — all to be under the control of the board of education or the board of health. Whether inspectors, examiners, and nurses shall be directed by the board of education or the board of health is a question that it is impossible to decide without knowledge of local conditions. So far as state and county organizations are concerned, it is clear that whatever the boards of health may do, it will be necessary for state and county superintendents of education to equip themselves with the machinery above recommended. In cities it is quite clear that a board of education should be responsible for all of the machinery suggested, excepting the three divisions that have to do with work hitherto considered as protection against transmissible diseases, namely, inspection, examination, district visiting. In Cleveland these are school duties. In New York they are duties of the health department. Boston has school nurses and health department physicians. The state law of Massachusetts provides that where health boards do not examine school children, school boards may spend money for the purpose. As to inspection for transmissible diseases, it seems quite clear that health boards should not delegate their authority or responsibility to any other body, for they alone are accountable to their communities for protection against contagion. It is clear, too, that in the interest of community health, departments of health are justified in pointing out in advance of contagion those children most likely to become a menace. Similar grounds of public interest justify the health boards in sending nurses and physicians to the home as a means of getting things done. Dr. Biggs feels that responsibility for the physical welfare of school children will strengthen health work in all cities, and, given proper interest on the part of school officials, should make possible universal coöperation in a constructive programme. On the other hand, he believes that division of responsibility between school and health boards will weaken both in their appeals for funds and for support of a constructive programme. I have heard principals and superintendents maintain also that the moral effect of a visit to the school by a representative of the health board vested with powers of that board was much greater than a visit by a representative of the school board. They further allege that a physician coming from the outside is more apt to see things that need correction and less apt to accept excuses than an inspector who feels that he belongs to the same working group as the school-teacher. Because the follow-up work in the homes incident to successful use of knowledge gained at school involves so many sanitary remedies, it is theoretically better organization to hold the health authority responsible. CHAPTER XXVIII PRESENT ORGANIZATION OF SCHOOL HYGIENE IN NEW YORK CITY Many of the elements of the machinery outlined in the preceding chapter already exist in New York City. All of them brought together, either by amalgamation or by proper coördination, would present a very strong front. Unfortunately, however, there is not only unsatisfactory team work, but the efficiency of individual parts is seriously questioned by the heads of the health and school departments. The inspection for contagious diseases, the examination for physical defects, the follow-up work by nurses and physicians, are in charge of the department of health. Physical training and athletics for elementary and high schools, winter recreation centers, and vacation playgrounds are under directors and assistants employed by the board of education. Heretofore inadequate powers and inadequate assistance for training or for research have been given to the physical director. The city superintendent of schools, in his report for the year 1907, presented to the board of education in January, 1908, declares that the "present arrangements have been inadequate. . . . In only 248 schools less than half the total number were any examinations for possible diseases made. In these 248 schools not more than one third of the pupils were examined. It is only a few months since any examinations for physical defects were made outside of the boroughs of Manhattan and The Bronx, and then only on account of the New York Committee on the Physical Welfare of School Children." As is so often the case, it is difficult to decide the merits of a method that has not been efficiently executed. The department of health has not hitherto done its best in its school relations. The commissioner of health, in a public interview, expresses resentment at the strictures by the school authorities. Yet in 1907 he permitted to accumulate an unexpended balance of $33,000 specifically voted for school inspectors, and repeatedly tried to have this amount transferred to other purposes. The interest of the Bureau of Municipal Research in municipal budgets that tell for what purposes money is voted and then prevent transfers without full publicity, preserved this particular fund. Moreover, the discussion that prevented its diversion from physical examinations strengthened the health department's interest in this important responsibility. Neither physicians nor nurses have been adequately supervised. Instead of seeing that defects were removed, the department of health sent out postal cards like the following: "This Notice Does NOT Exclude This Child From School" is hereby informed that a physical examination of this child seems to show an abnormal condition of the.. Remarks Nose Throat and Leut So Anaenue Take this child to your family physician for treatment and advice. Take this card with you to the family physician. THOMAS DARLINGTON, M. D., HERMANN M. BIGGS, M. D., Commissioner of Health. From 118,000 such notices sent out only 9600 replies were received, of which only one in twenty stated that attention had actually been given the needy child. The |