A Plea for the Systematic Annual and Uni-Versal Examination of School Children’s Eyes and Ears
- Author:
Fkank ALLroiiT, M.D.
Professor of Clinical Ophthalmology and Otology, Northwestern Medical School, Chicago, III.
Tlie vast amount of money invested in school properties and annual budgets, cannot be well expended unless the children are in a proper physical condition to receive instruction. Unless children receive and absorb the instruction presented they cannot; be properly educated. Unless children are properly educated they do not become useful citizens; instead they, are apt to develop idle and criminal tendencies and become financial and moral charges upon the State. If, therefore, it is deemed advisable to materially mitigate idleness and crime, and to increase the ranks of self-respecting and self-supporting men and women, then the logical conclusion is, educate them ; and if physical defects hamper their educational progress, then eliminate, as far as possible, such physical defects, and allow the children at least the physical possibility of profiting by what the public schools offer.
There is much to be said concerning the specific and intimate connection existing between a child’s general health and his school progress, but as my portion of this symposium refers only to the eyes and oars of school children, I shall be compelled to limit myself to this phase of the subject. It should be remembered, however, that this topic is by no means restricted in its character, for, with the exception of mental capacity, nothing is so essential to the acquirement of an education as good sight and hearing. A child who cannot see well at a distance is debarred from participation in the important blackboard and other distant demonstrations which play an essential role in modern educational methods; a child who cannot study without headache or fatigue soon forms a great distaste for books and acquires habits of idleness, with all its entailed consequences, while a child whose vision is generally impaired by cataracts, corneal scars, intra-ocular diseases, etc., becomes an almost hopeless proposition so far as education is concerned. The difficulties which a deaf child experiences in the effort to acquire an education must be apparent to everyone, while a child with discharging and foul ears is not only in danger of death, but is an infective menace to the entire school.
Is it asking too much of educators and lawmakers to see that the physical condition of children is such as to put no obstacle in the way of their receiving an education in our public schools ? Our public schools are a public trust, a trust given by the people to certain officers into whose hands is confided the welfare of our schools and their pupils. These officers voluntarily assume their duties; they undertake to manage the schools in the best interests of the children,the community and the nation. They require attendance and establish meeting places where they stand in loco parentis and where the children pass the major portion of their waking hours. They should not be satisfied then with the mere presenting of knowledge to the young and unformed mind, but should accompany it with all the solicitude and care extended to fortunate children by loving and watchful parents, for it must be remembered that many children in our public schools are fatherless or motherless or, Heaven knows, might better be, and that they, will receive behind the portals of our public schools all the love and kindness they are likely to know. I do not wish to be understood as criticizing our schools or accusing their officers of neglect or carelessness, for such, believe me, is not the case. Enormous strides have been made along these and all other lines during tho last few years, but much remains to be done and it is to be hoped and believed that tho same degree of energy and enthusiasm which has already inspired the accomplishment of so much good work in the past, will be the means of accomplishing an even greater work in the future.
The systematic physical examination of pupils by medical school inspectors and the efficient cooperation of school nurses is one of the biggest steps that has ever been taken in the direction of improving the physical condition of school children and the results show enormous benefit. These results can be greatly increased by delegating to the school teachers themselves tho practical examination of the eyes, ears, noses and throats of tho children. Fortunately, this is a field which can be efficiently covered by. the teacher, for, after the examination, although the teacher cannot and should not make a diagnosis, sufficient data will have been obtained to enable her to know that the child has passed either a satisfactory examination, or has some defect which may be diagnosed and treated by the physician to whom the case is ultimately referred. This examination consists in ascertaining a few simple facts as follows: 1. Does the pupil habitually suffer from inflamed lids or eyes ?
2. Does the pupil fail to read a majority of the letters in the number XX line of Snellen’s test types with either eye?
3. Do the eyes and head habitually grow heavy and painful after study?
Does the pupil appear to be “cross-eyed”?
Does the pupil complain of earache in either ear ?
Does pus or a foul odor proceed from either ear ?
7. Does the pupil fail to hear with either ear an ordinary voice at 20 feet, in a quiet room ?
8. Is the pupil frequently subject to “colds in the head” and discharges from the nose and throat ?
Is the pupil an habitual “mouth-breather” ?
If an affirmative answer is found to any of these questions the pupil should be given a printed card of warning to be handed to the parent, which should read as follows: Card of Warning to Parents. After due consideration it is believed that your child has some eye, ear, nose or throat disease for which your family physician or some specialist should be at once consulted. It is earnestly requested that this matter be not neglected.
Kespectfully, It will be observed that these cards are not obligatory in their character and that they leave the choice of a physician with the parent. If the matter is not attended to, the teacher or the school nurse should take the matter in hand and endeavor to win compliance with the plan. The examinations should be made early in the school year, say in September, in order to bring the plan to completion and observe results before the end of the school year. It is recommended that each teacher examine the pupils in her own room, not only because she is familiar with the children and their complaints, but because it subdivides the work, so that it does not become a strain upon any one person. The reports can be handed to the principal, who should retain them for future reference. Inasmuch as a school room rarely contains more than forty pupils, and each examination can be easily made in five minutes, a whole class may be examined in a few hours. In this way the school children of an entire city, no matter how large, can easily be tested in less than a day’s time, and the benefits which must follow are sure to be large. The expense is slight, as the only supplies necessary are the Snellen’s test-types with teachers’ instructions attached, together with the warning cards to parents and very simple record blanks. A city like Chicago, for instance, can bo annually tested at an expense which should not exceed five hundred dollars per annum, a truly insignificant amount, when one considers the great benefit which must inevitably follow. Teachers need not feel incapable of making these tests, for the questions are simple, and yet when analyzed will be found to be so comprehensive in character as to detect at least 90 per cent of serious eye, ear, nose or throat defects. This plan, which I proposed some years ago, is now in quite general use throughout the United States, and has been endorsed by the American Medical Association, most of the state medical societies, many boards of health and education, and has been made obligatory by law in Vermont, Connecticut and Massachusetts. I give the provisions of the Vermont law, the best which has yet been paseed.
“Section 1. The state board of health and the superintendent of education shall prepare or cause to be prepared suitable test cards, blanks, record books, and other needful appliances to be used in testing the sight and hearing of pupils in public schools, and necessary instructions for their use; and the superintendent of education shall furnish the same free of expense to every school in the state. The superintendent, principal, or teacher in every school during the month of September in each year shall test the sight and hearing of all pupils under his charge, and keep a record of such examinations according to the instructions furnished, and shall notify in writing the parent or guardian of every pupil who shall be found to have any defect of vision or hearing, or diseases of eyes or ears, with a brief statement of such defect or disease, and shall make a written report of all such examinations to the superintendent of education as he may require.
“Section 2. The state auditor is hereby directed to draw his order on the state treasurer for such sums and at such times as the superintendent of education, with the approval of the state board of health, may recpiire to carry out the provisions of this act. The total expense under this act shall not exceed six hundred ($(500.00) dollars in any biennial term ending .Tune 30.
“Section 3. This act shall take effect July 1, 1905.”
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