An Examination of the Eyes, Ears, and Throats of Children in the Public Schools of Jefferson City, Missouri
- Author:
Sneed, M.D., and Guy Monteose Whipple, Ph.D.
Purpose. The public schools of Jefferson City have an enrolment of some 1530 pupils. The physical examination which is here reported occupied the greater portion of the school year, 1907-8. The primary purpose was to test the eyesight and hearing of 1000 white and 100 colored children, but as the work progressed its scope was widened to include observations of the throat, nose, etc. An inquiry was then made as to the correlation of sensory defects with school standings. Some attention was also paid to the value of issuing cards of warning to parents.
Method. As a preliminary to the work a printed record-sheet was supplied to each child to be filled out as far as possible by the child himself, or by the teacher for the children in the lower grades. On this were first recorded certain scholastic and personal data (building, room, grade, teacher, name of pupil, sex, years in school, color of hair and eyes, name and address of parents, etc.) ; then followed questions concerning the pupil’s physiological condition, e. g., Does the pupil habitually suffer from inflamed eyes or lids ? Do the eyes and head habitually grow weary and painful after study ? Does the pupil appear to be cross-eyed ? Does the pupil complain of earache in either ear? Does matter (pus) of foul odor proceed from either ear ? Is the pupil frequently subject to colds in the head, and discharges from the nose or throat ?f Blank spaces for remarks were used to note the presence of abnor?”The work of examination was done by Dr Sneed under the direction of Dr Whipple, then Acting Professor of Educational Psychology in the University of Missouri. Dr Sneed undertook the work from personal interest and served as Medical Inspector without pay. The Superintendent of Schools and the School Board of the city facilitated the investigation by giving him an official appointment and aided him in many other ways. fMost of these questions are based upon those devised by Dr Frank Allport of Chicago and incorporated by him upon the charts published especially for school tests by F. A. Hardy & Co. of that city. malities, such as goitre, enlarged tonsils, skin diseases, and other defects.
The direct personal examination of each child was executed by Doctor Sneed as thoroughly as possible without the use of instruments or material other than the test-chart, the watch, and a card or thin ruler for exposing the conjunctiva. This examination comprised the following details. First, the lids were everted and examined for the presence of trachoma, granulated lids, or other inflammatory condition of the conjunctiva. Secondly, the throat was inspected for the presence of enlarged tonsils or other abnormal conditions. (Careful throat ins’pection was made upon only 377 children.) The tonsils were considered enlarged if they were somewhat larger than an almond. Special attention was given to the throat and nasal passages of those pupils who were reported as “hard of hearing,” “subject to colds in the head,” or as “habitual mouth breathers.” These pupils were examined for adenoids in so far as was feasible without direct digital exploration.
Thirdly, acuity of vision was tested by the ordinary Snellen types, with proper precautions to avoid the memorizing of the testletters. Defective vision was recorded upon failure to read as many as four letters in the 20-foot line.*
Fourthly, acuity of hearing was tested by placing the pupil 20 feet distant, with his back to the examiner and with the untested ear closed by firm pressure of the fleshy portion of the palm at the base of the thumb, while short, vocalized words or sentences,?e. g., “Do you hear?” “Hoav old are you?”, etc.,?were spoken in a normal or conversational tone of voice. The watch-test was also used in some instances. Like the test of visual acuity, this test of auditory acuity is extremely rough and calculated to detect only pronounced incapacity, since the range of ordinary speech is in the neighborhood of one hundred feet or more. Chief Results. In Table 1 we have summarized our data for the 1000 white children and the 100 colored children. In our subsequent discussion, unless the contrary be noted, we refer to the results for the white children alone. ?It is important to make clear that this simple distance-test, which is the one commonly employed in the examination of school-children, usually fails to detect hyperopia, unless complicated with appreciable astigmatism, yet hyperopia is the commonest type of defect in younger children and the source of serious eye-strain. In the absence of supplementary tests, our only way of “catching” these cases was through the report of headache or pain in the eyes after studying.
TABLE I. PERCENTAGE DEFECTIVE AMONG 1000 WHITE AND 100 COLORED CHILDREN. Defects White Colored Defective vision (Snellen test) 36.5 19 Defective vision (one eye only) 13.8 7 Defective vision (both eyes) 22.7 12 Defective vision (first three grades, 147 pupils) 29.4 Defective vision (high school, 116 pupils) 40.5 Pain after using eyes at study 29.5 34 Probably needing glasses 41.0 ? Wearing glasses when examined 3.8 5 Cross-eyed 3.0 2 Inflamed lids 17.5 11 Trachoma 8.3 1 Defective hearing 7.7 7 Defective hearing (one ear only) (5.4 4 Defective hearing (both ears) 1.3 3 Discharging ears 4.0 Suffer from ear-ache 11.3 17 Mouth breathers 24.2 10 Frequent colds 38.7 22 Tonsils enlarged 22.8 1 Goiter 3.G 1 Miscellaneous abnormalities 2.(5 G Cards of warning issued, 551. Number who heeded the warning, 74 of tlie 423 that could be investigated, or 17.5 per cent.
Comments on the results. The recorded percentage of negro children who suffer from pain in the eyes or ears is unquestionably too high, for we discovered that these children took a peculiar pride in having as many “symptoms” as possible, and that many of them seemed to consider sore eyes a sign of intellectual prowess. When these two items are excluded, a comparison of the two races shows clearly the superior physical condition of the negro children. Incidentally, we noted that the negro children had by far the better teeth.
The percentage of those who need glasses (41.0) is determined by adding to the 365 children who failed with the Snellen test, 45 other children who passed the test but complained of headache or painful eyes after study. We have, in other words, estimated 4.5 per cent of undetected hyperopia. Our final percentage of defect is much lower than that recorded by Risley and other competent investigators by means of instrumental tests. We deem it a very conservative statement, therefore, to say that four in ten of the children in the public schools of Jefferson City need glasses. Compare with this the fact that less than four in a hundred are actually wearing them! When the unquestioned physical and mental handicap of defective vision is considered, the loss in efficiency in the public school system is surely most impressive. Several of the teachers in Jefferson City can attest the radical improvement in scholarship and behavior which has resulted from the adoption of glasses by some of the pupils examined.
Comparison of the younger and the older pupils shows that inability to pass the Snellen test is a third more prevalent in the high than in the primary school, largely, of course, owing to the increase of myopia through the grades. Four pupils in every ten in the high school are unable to read the normal 20-foot line. What, then, can they be expected to gain from blackboard exercises ? The relation of visual defect to school standing has been computed on the basis of the grading-marks assigned “by the teachers. Five marks are now in use, A, B, C, X, and Xm, which are used to indicate superior, average, poor, failure, and very dull (or mentally deficient), respectively. The relation of these grades to visual defect is represented in Table 2. From this table it is evident that defective vision is an appreciable positive factor in handicapping the work of the child at his studies.*
TABLE 2. Relation of School Standing and Visual Defect. School work satisfactory not satisfactory Vision good 469 166 Vision defective 228 137 “With regard to trachoma we cannot be certain that all of the 84 cases recorded are genuine, but, even if only half of them are real trachoma, the situation is sufficiently startling when it is remembered that three-fourths of all untreated cases result in blindness, and that the disease is highly contagious. Infection is spread by fingers, handkerchiefs, towels, etc. A single undetected and untreated case of trachoma in the public schools may mean the infection of several other innocent children, whose life for future usefulness may be ruined thereby. The presence of this malady alone is enough to justify the vigorous prosecution of systematic medical inspection, as has been amply shown in New York City. Among the abnormalities recorded are a double uvula, an imperforate ear (no opening to the ear-passage), a congenital *By the method of correlation by presence and absence, as developed by Yule and other mathematicians, we may compute the index of correlation here to be + 0.22, with a probable error of about .03. This result confirms the conclusions of practically all who bare Investigated this relation.
cataract, and a peculiar case of what we have called a “ticking ear,” in which a clicking or cricket-like sound, synchronous with the pulse, emanated from one ear with sufficient intensity to be heard by the examiner two feet away. Several cases of chicken pox and scabies (itch) were also found among the pupils.
Cards of warning, 551 in number, were sent to parents whose children were known to be suffering from defects which hindered their progress in school. These cards were of the usual form: they called attention to the existence of some physical defect and earnestly requested the parents to consult the family-physician with a view to alleviating the infirmity. Several weeks after the entire examination had been finished, an effort was made to determine how many parents had heeded the request. Of the 423 pupils who could be asked, 74, or 17.5 per cent, reported that their parents had taken them to a physician for consultation. At first, thought, this percentage may seem low, but we believe that the outcome is fairly encouraging wThen we consider the general public’s present state of apathy and ignorance upon matters of hygiene and sanitation. This result indicates, in our opinion, that an important feature of medical inspection should be the planning of method? for engaging the sympathetic and intelligent cooperation of parents. A tactfully conducted series of general lectures before parents’ meetings might contribute toward this end, but doubtless the best solution lies in the employment of school nurses to “follow up” the cases reported by the inspector.
In the main, the work at JefFerson City was well received : some half-dozen parents raised minor objections to the work of inspection, objections which turned out usually to spring from a misunderstanding of the purpose of the examination; on the other hand, not a few parents expressed their warm appreciation of the work, while the medical profession strongly endorsed it.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.