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The medical inspection of schools in Boston, U.S.A.
136
THE
M E D I C A L I N S P E C T I O N OF S C H O O L S I N BOSTON, U.S.A.
The following table shows the number of animals killed, which failed to react to the tuberculin test, and had been pronounced free from tuberculosis, the Commonwealth brand having been placed upon the right hip : - Animals.
Number killed,
Number tuberculous,
Cows . . . . . . . . . Steers . . . . . . . . .
62 I
4 --
--
Total
63
4
6"34
......
Percentage tuberculous.
T H E M E D I C A L I N S P E C T I O N OF S C H O O L S I N BOSTON, U.S.A. THE need of medical inspection of schools, for the purpose of detecting contagious and other diseases among the school children, was brought to the attention of the Mayor and City Council in 1892 , and for this purpose an appropriation was then secured. A delay for several months was occasioned in securing the approval of the School Committee, and then the Mayor withdrew h,s approval by objecting to the commencement of the work that year. I n i893 , and again in I894 , the Board of Health asked for an appropriation for this work, and each time it was withheld, and the work was delayed, until diphtheria had assumed the proportions of an epidemic in September, i894 , and was steadily increasing. Under these circumstances, the Mayor, in October, expressed a desire to have the Board of Health set in operation its plan for medical examination of school children. The Board of Health at once selected fifty physicians for this purpose, divided the city into fifty school districts, and began school inspection on November ist, 1894. These physicians are appointed Medical Inspectors of Schools and Agents of the Board of Health, and are authorised to visit each school daily, during the early part of the morning session, and to examine all pupils who complain, or appear to the teachers to be ill. If an inspector finds a pupil showing symptoms of any contagious disease, or is otherwise too ill to remain in school, he will advise the teacher to send the pupil home for the temporary observation of its parents or family physician. H e will also give such professional advice as may be required by the teachers to aid them in carrying out all laws and regulations pertaining to contagious diseases, vaccination, and general school hygiene, whose enforcement belongs to the School Committee or Board of Health. In the examination of throats, the Medical Inspectors will use only the wooden tongue-depressors which are furnished by
the Board of Health, each of which is to be burned after a si,gle use. No pupil is to be prescribed for or advised hy the Medical Inspector, excepting such general advice as may be sought through the intervention of the teacher in behalf of poor children. The Medical Inspectors of Schools are also authorised agents of the Board of Health, and wilJ, on notification from said Board, visit all cases of scarlet fever and diphtheria at the homes of the patients, for the sole purpose of examining the places and plans of their isolation ; and, as such. agents, they will report to the Board of Health their approval or disapproval of such places and plans of isolation. Such medical agent will not prescribe advice or criticise anything beyond that which pertains strictly to the isolation of the patient, and will carefully avoid any word or act which may be construed as an infringement upan the rights of the family or attending physician~ H e will visit the patient as often as may be necessary to inform himself as to the continued isolation of the case. No case of scarlet fever or diphtheria will be discharged from isolation until its complete recovery is certified to the Board of Health by one of its medical agents; and such certificates of recovery will be based on the complete disappearance of desquamation in cases of scarlet fever, and on the absence of the Klebs-Loeffler bacillus in cases of diphtheriawthe latter to be shown hy bacteriological examination made satisfactory to the Board of Health. The reports of the Medical Inspectors of Schools, for the months of November and December, show that 4,962 pupils were presented to them lot" examination, and 564 were found to be too ill to remain in school for the time being~ 212 were suffering from contagious diseases, 43 were suffering from diphtheria, and I 3 i were too ill from troubles in the ears and eyes to be at school. Diseases in the throat were most prevalent, and were found in 1,749 pupils. Diseases of the eye, ear, and spine are found sufficiently often among the school children to warrant a mo~e careful examination to find those who may be suffering from mild forms or early stages of these diseases. It often happens that school children suffer serious and unrecognised disadvantages by reason of defective eyesight, deficient hearing, or a commencing deformity of the spine. The mild forms and early stages of these ills would not generally be seen and appreciated by the teachers, and it would be unreasonable to expect them to detect illnesses which require special skill on the part of the physician to recognise. The Board of Health will endeavour to pursue the inspection as far as it may be found to be agreeable to the school management and profitable to the highest interests of school hygiene.--/Zram
the 23rd A~znual Report of lhe City of Boston for the Year I894.
THE
M E D I C A L I N S P E C T I O N OF S C H O O L S I N BOSTON, U.S.A.
The following table shows the number of animals killed, which failed to react to the tuberculin test, and had been pronounced free from tuberculosis, the Commonwealth brand having been placed upon the right hip : - Animals.
Number killed,
Number tuberculous,
Cows . . . . . . . . . Steers . . . . . . . . .
62 I
4 --
--
Total
63
4
6"34
......
Percentage tuberculous.
T H E M E D I C A L I N S P E C T I O N OF S C H O O L S I N BOSTON, U.S.A. THE need of medical inspection of schools, for the purpose of detecting contagious and other diseases among the school children, was brought to the attention of the Mayor and City Council in 1892 , and for this purpose an appropriation was then secured. A delay for several months was occasioned in securing the approval of the School Committee, and then the Mayor withdrew h,s approval by objecting to the commencement of the work that year. I n i893 , and again in I894 , the Board of Health asked for an appropriation for this work, and each time it was withheld, and the work was delayed, until diphtheria had assumed the proportions of an epidemic in September, i894 , and was steadily increasing. Under these circumstances, the Mayor, in October, expressed a desire to have the Board of Health set in operation its plan for medical examination of school children. The Board of Health at once selected fifty physicians for this purpose, divided the city into fifty school districts, and began school inspection on November ist, 1894. These physicians are appointed Medical Inspectors of Schools and Agents of the Board of Health, and are authorised to visit each school daily, during the early part of the morning session, and to examine all pupils who complain, or appear to the teachers to be ill. If an inspector finds a pupil showing symptoms of any contagious disease, or is otherwise too ill to remain in school, he will advise the teacher to send the pupil home for the temporary observation of its parents or family physician. H e will also give such professional advice as may be required by the teachers to aid them in carrying out all laws and regulations pertaining to contagious diseases, vaccination, and general school hygiene, whose enforcement belongs to the School Committee or Board of Health. In the examination of throats, the Medical Inspectors will use only the wooden tongue-depressors which are furnished by
the Board of Health, each of which is to be burned after a si,gle use. No pupil is to be prescribed for or advised hy the Medical Inspector, excepting such general advice as may be sought through the intervention of the teacher in behalf of poor children. The Medical Inspectors of Schools are also authorised agents of the Board of Health, and wilJ, on notification from said Board, visit all cases of scarlet fever and diphtheria at the homes of the patients, for the sole purpose of examining the places and plans of their isolation ; and, as such. agents, they will report to the Board of Health their approval or disapproval of such places and plans of isolation. Such medical agent will not prescribe advice or criticise anything beyond that which pertains strictly to the isolation of the patient, and will carefully avoid any word or act which may be construed as an infringement upan the rights of the family or attending physician~ H e will visit the patient as often as may be necessary to inform himself as to the continued isolation of the case. No case of scarlet fever or diphtheria will be discharged from isolation until its complete recovery is certified to the Board of Health by one of its medical agents; and such certificates of recovery will be based on the complete disappearance of desquamation in cases of scarlet fever, and on the absence of the Klebs-Loeffler bacillus in cases of diphtheriawthe latter to be shown hy bacteriological examination made satisfactory to the Board of Health. The reports of the Medical Inspectors of Schools, for the months of November and December, show that 4,962 pupils were presented to them lot" examination, and 564 were found to be too ill to remain in school for the time being~ 212 were suffering from contagious diseases, 43 were suffering from diphtheria, and I 3 i were too ill from troubles in the ears and eyes to be at school. Diseases in the throat were most prevalent, and were found in 1,749 pupils. Diseases of the eye, ear, and spine are found sufficiently often among the school children to warrant a mo~e careful examination to find those who may be suffering from mild forms or early stages of these diseases. It often happens that school children suffer serious and unrecognised disadvantages by reason of defective eyesight, deficient hearing, or a commencing deformity of the spine. The mild forms and early stages of these ills would not generally be seen and appreciated by the teachers, and it would be unreasonable to expect them to detect illnesses which require special skill on the part of the physician to recognise. The Board of Health will endeavour to pursue the inspection as far as it may be found to be agreeable to the school management and profitable to the highest interests of school hygiene.--/Zram
the 23rd A~znual Report of lhe City of Boston for the Year I894.