Medical and Dental Inspection in the Cleveland Schools
The Psychological Clinic Vol. IV. USTo. 4. June 15; 1910. y :Author: J. E. Wallace Wallust, Ph.D., Normal Training School, Cleveland, Ohio. I. The Development of Medical School Inspection.
In 1906 the Board of Health of Cleveland appointed twentysix ward physicians, a part of whose duties consisted in inspecting every other day the public and parochial schools of their districts for the detection and exclusion from the schools, of pupils suffering from contagious and communicable diseases. But excluding children, in conformity with the law, with such communicable diseases as pediculosis, scabies, impetigo, etc., created another problem.
Many children thus excluded remained out of school for days; they received no corrective treatment at home, hence when they returned they were often in a worse condition than when they left; their exclusion seriously handicapped the regular work of the classroom, for these pupils frequently stood in greatest need of the classroom processes, and they had to be excluded in large numbers owing to the enormous prevalence of some form or other of communicable disease. In a number of the congested foreign districts of the city, conditions were such that not only would exclusion result in a breakdown of the system from the point of view of school attendance, but a large percentage of children were forced to labor under the handicap of needless suffering, owing to the ignorance, indifference, or poverty of the parents.
To checkmate the evils due to those conditions and to demonstrate to the Board of Education the importance of a system of medical inspection that should embrace examination for physical defects, certain inspectors, working through the Sanitation Committee of the Chamber of Commerce, volunteered their services without compensation if the Board of Education would provide inspection stations in those schools in which the need was the most pressing. The Board established five of these stations in schools which drained large foreign populations, each station in charge of a graduate nurse of the Visiting Nurses’ Association. The first was organized by L. W. Childs, M.D., at the Murray Hill school in 1908. School dispensaries or clinics, the first and perhaps still the only ones of the sort in the country, were connected with two of these stations (Murray Hill and Marion). Three others were subsequently added. The equipment of these clinics, provided at the expense of the School Board, varies, but consists mainly of diagnostic appliances for examining the ear, nose and throat, eye test cards, instruments for removing adenoids and tonsils and for performing the simpler operations, ointments, solutions for treating communicable diseases, an instrument case, a metal stand for basins, glass top table, couch, enameled chairs, etc. While treatment at the clinic has not been contemplated, emergency cases receive prompt attention, and at one of the schools, the Murray Hill (and in a measure, at a couple of the others also), all cases of infection, of wax and suppurating ears, atrophic rhinitis, and all marked cases of adenoids and hypertrophied tonsils have received remedial or operative treatment.
The inspection work has been rendered practically effective, however, largely through the “follow up” work and the diversified ministration of the school nurse. She makes a record of the examination, and sends a copy to the child’s parents. She visits the home to ascertain whether the physician’s advice has been followed. If it has not, recourse is had to the gentle art of suasion, or in extreme cases of neglect the juvenile court is invoked. Indigent parents are advised to take the child to a free dispensary or hospital clinic. She looks after many of the minor troubles while the child remains in school, attends to ordinary dressings and the child’s hygiene in general, inspects the rooms daily and treats at the dispensary the simpler infections of the skin and head, while referring the more complicated cases to the medical inspector. After treatment she follows the child home and instructs the mother how to continue treatment, or, in case the mother is employed, takes personal charge. She also teaches the older girls in school how to apply bandages and antiseptics, how to prepare common disinfectants and antidotes, and explains the importance of sanitation and personal cleanliness. She gives baths to the girls where showers are provided. Hers is a diversified calling, filled with noble achievement. In one month in the Murray Hill school, nurses’ aid was given to 680 cases while 75 homes were visited. A monthly report of nurses’ aid in the Harmon school included 195 baths, 215 treatments for impetigo, 50 for pediculosis, 50 ocular cases were referred to the Humane Society and one to the Blind Institute. Similar cases from another school in a congested section (Eagle) are frequently referred to dental, medical, and babies’ dispensaries, and family physicians. In 1907 through the cooperation of nurses, physicians, teachers, principals, parents, dispensaries, free hospital clinics, and philanthropic organizations, over 3300 pupils received aid, of the following nature: Number. Per cent.
Glasses secured by , 990 29.2 Other eye treatment 1016 30. Ear treatment 228 6.7 Nasal treatment 379 11.1 Dental treatment 664 19.6 Unclassified Ill 3.4 Total 3388 100. To the thousands of children and parents who have profited from this humanitarian and philanthropic ministration, the school nurse has become a guardian angel and the inspector a patron saint. There has been no frenzied outcry in Cleveland against this physical welfare work,?the transcendent value of which has been obvious upon the very surface,?either on the part of ignorant or superstitious parents, or studied opponents of “communism” or “socialism.” Objections, so far as they have been at all heard, have been directed by parents against operations, or by physicians against free treatments. Some parents object to the removal of tonsils, through the mistaken fear that this will injure the voice; and others to the wearing of glasses, because they fear that once worn they can never be discarded.
What a boon this work has been to the schools! Instead of nithlessly excluding infected children from the schools and thereby clogging the school machinery, the district physician has given Avay to the medical inspector and the school nurse, and the child has remained in school without the danger of infecting his fellows. The statistics from one of the medical stations (Marion school) show most impressively how irregular attendance can be effectually counteracted. It has been computed by the Principal (Miss 0’]STeill) that the school nurse and dispensary between January 1 and June 1, 1909, saved 1871 days for the child and the school. Without these adjuncts of the school the following cases of exclusion would have been necessary: 43 infections for 5 days, or 215 days.
118 cases of conjunctivitis for 5 days 590 23 ” ” scabies for 5 days 115 23 ” ” scabies for 5 days 115 25 ” ” ringworm for 10 days 250 57 ” ” pediculosis of head for 3 days 171 6 ” ” pediculosis of skin for 10 days GO 94 ” ” impetigo for 5 days 470 Total 1871 With a rigidly enforced exclusion law these children, and others who might have been infected by them, would have been deprived of the processes of the schools for about ten years in the aggregate, at a tremendous economic loss to the taxpayer. This enormous waste was obviated at a merely nominal cost to the community. This saving takes no account of the increased working efficiency which resulted from properly caring for the following 283 non-communicable or private ailments during the corresponding period: 79 cases of minor injuries. 10 cases of* foreign bodies in eyes. 65 ” ” throat affections. 10 40 ” ” burns. 10 20 ” ” chapped hands. 9 19 ” ” ear affections. 7 12 ” ” nasal affections. 2 removed tonsils, eczema, adenoids. canker sores, cold sores.
To render this auxiliary work of the schools still more effectual, volunteer work in the direction of feeding indigent anaemic and underfed children has been started in some of the schools. The Philanthropic Committee of the Cleveland Federation of Women’s Clubs regularly serves a simple breakfast in the Eagle school to an average of thirty-six pupils per day. As a result of this hygienic and medical work the attendance records have reached unprecedented heights in these irregular districts. The principals estimate that 90 per cent of the affected pupils have remained in school who would in the absence of this service have dropped out for several days. This fact is of vital significance to the schools and the community in view of the contention of Ayres1 that irregular attendance isi the chief cause of backwardness and non-promotion, and that ill health is the chief cause of irregular attendance. He found that in ISTew York 43 per cent of the boys and 48 per cent of the girls of the 16,000 completing the eighth grade in 1909 were absent from school from illness. The net loss to the girls amounted to 3.5 per cent of the length of the term, and to the boys 3.2 per cent. The causes of these absences were: measles, 2108 ; scarlet fever, 1550; diphtheria, 1002; pneumonia, 621; whooping cough, 473; chicken pox, 387; mumps, 288; tonsilitis, 251; typhoid fever, 219; rheumatism, 200; malaria, 151. Without any system of medical inspection and nurses’ supervision in the ISTew York schools, these absences would probably have been increased from minor infections such as those which prevailed in the Marion school.
Since the work attempted in these stations has not contemplated a routine examination of every child, and since the form and completeness of the records kept have varied more or less with each inspector, it is impossible to state how many cases have been examined by the physicians since the work was launched, or how many defects (particularly the non-communicable physical abnormalities) have been discovered, or what the relative proportions of different kinds of physical defects are, or precisely how the influence upon mental retardation differs with different defects, or what have been the subsequent effects upon the physical growth, the increase in body weight, and the mental efficiency of the hygienic and medical treatment of the affected child. The magnitude of the tinspection work may be inferred, however, from the records at the Murray Hill and Marion schools, where, during the months of January, February, and March, 28,820 inspections were made. Moreover, I have been able to obtain three sets of reliable data, one from the printed records and two in response to a questionnaire. The first shows the ratio of the various physical defects obtaining among children in the better sections and congested districts of the city. During the academic year 1906-07 the department of physical training of the public schools examined 30,000 children with respect to the conditions of the eyes, ears, nose and throat only, in grades three to seven. The following table is based upon the examination of 1284: pupils in two schools, one in the “east end” and the other in a congested district:
East End. Congested District. Per cent. Per cent. Number examined 668 616 Wearing glasses 6.4 1.8 Defective vision 32.4 71.1 Other symptoms of eye trouble 27.8 35.2 Defective hearing 5.2 1.8 Diseased ears 8.9 12.8 Obstructed nasal breathing.. 45.1 57.1 Habitual mouth breathers… 12.1 14.7 Teeth very defective 1.3 15.7 Teeth very dirty 27.8 46.4 Average 18.55 28.4 98 THE PSYCHOLOGICAL CLINIC. Dr Childs has more recently made a routine examination of 425 pupils in the lower grades (from the second to the fifth) in the Murray Hill school, where 97 per cent of the school population is Italian, covering the ear, nose and throat, and has kindly supplied me with the results of his careful survey, to wit: Per cent. Retraction of drum membranes of both ears 32 Retraction of membrane of one ear 16 Impaired bearing 22 Enlargement of both tonsils 22 Enlargement of one tonsil 3Y2 Adenoids 13 Impacted wax in ears 13 Enlarged cervical glands 10 Goitre 7 Atrophic rhinitis 5 Deviated septum 4 Suppurating ears 2 Hypertrophied inferior turbinals 2 In a still later examination of 120 sixth, seventh, and eighth grade girls in the same school, 32 per cent suffered from goitre, and 16 per cent from anaemia. In a routine examination of the 972 pupils in the eight grades of Mayflower school (station opened March 25, 1909), the inspector, Dr S. A. Weisenberg, to whom I am indebted for a full report, found the most prevalent troubles to be the following: Per cent. Pediculosis 51 Defective eyesight ., 7 Miscellaneous eye cases 13 Eye troubles, total 20 Miscellaneous throat cases 8.4 Hypertrophied tonsils 4.5 Tonsilitis 2.7 Adenoids 2.2 Adenitis 1.3 Throat troubles, total 19.1 Impetigo 9 Injuries 8.2 Miscellaneous ear cases 4.5 Chronic rhinitis 1.6 Nasal defects 1.3 Nose troubles, total 2.9 Over 78 per cent of these children were Jewish, nearly half of these being Russian Jews (47.9 per cent). The inspectors agree that adenoids, enlarged tonsils and defective breathing (with malnutrition, epilepsy and chorea) are the physical defects which most retard mental progress. These observations agree with Ayres’s1 rating of the relative capacities for work of normals and various physical defectives. He finds the percentages of handicap or loss of efficiency as follows : defective teeth, 6 per cent; defective breathing, 7 per cent; enlarged tonsils, 9 per cent; adenoids, 14 per cent; and enlarged glands, 15 per cent (based on the time required to finish the elementary grades). That the conditions revealed by these medical surveys in Cleveland are paralleled in other centers of population may be seen from the following tabulation of a few of the available returns.
Among 1442 children, largely of Irish, Jewish, and Italian stock, in three schools out of a total of 142,000 examined in ISTew York City in 1908, 73 per cent suffered from defective teeth, 59 per cent from nasal breathing, 42 per cent from visual defects, 39 per cent from hypertrophicd tonsils, and 15 per cent from anaemia. Based upon another medical census of 23,000 children m all grades, the following distribution was found at the ages of six and fifteen:
At 6 years. At 15 years. Defective teeth 65 per cent 31 per cent Enlarged tonsils 40 14 ” glands 40 7 Adenoids …. 23 3 Defective breathing 23 9 ” vision .17 26
About 80 per cent of these children were physically defective in some way. Gland, mouth, and throat troubles, it will be observed, are typical childhood infirmities, while defective vision (as well as defective teeth) constitutes the bane of youth. In Worcester ^58 pupils examined in two elementary schools showed enlarged glands in 64.5 per cent of the cases, affected tonsils in 37 per cent, adenoids (“suspected”) in 21 per cent, eye defects in 15 per cent, anaemia in 4.5 per cent, poor nutrition in 5.5 per cent, medium nutrition in 36 per cent, and good nutrition in 57.5 per cent. Decayed teeth were found in 86.5 per cent of the pupils, the average number per child being 4.85, and the corresponding averages in the different grades (given in order from the first to the ninth grade), 7, 6.54, 6.08, 4.90, 4, 3.50, 4, 4, and 3.66 per cent. There is a noticeable foiling off in the five upper grades. The figures show a wide variation from grade to grade in some of the defects. In Chicago in 1909, 123,900 children were examined (this was not an ultimate examination, only the major defects ^yres, Leonard P. The Effect of Physical Defects on School Progress. The Psychological Clinic, Vol. Ill, No. 3, May 15, 1909, p. 71. being noticed), and of these about 36 per cent had defective teeth, 22 per cent enlarged tonsils, 13 per cent enlarged glands, 5 1/2 per cent nasal defects, 3 x/2 Per cen^ adenoids, and 2 1/3 per cent hearing defects. Of more than 5000 children examined in Los Angeles, ‘ 61 per cent suffered from defective eyesight, 31 per cent from adenoids, 25 per cent from enlarged tonsils, and 22 per cent from defective hearing. In the rural districts of St. Louis County1 the vision was below normal in one or two eyes in 30.6 per cent of the 2000 cases examined, less than two-thirds normal in 14 per cent, less than one-half normal in 3 per cent (these figures do not include hyperopia or mild astigmatism), the hearing was defective in either of the ears in 7 per cent, somewhat less than 2 per cent could not hear a whisper with either ear, and 0.9 per cent were troubled with serious adenoids. Of the children examined in Jefferson City, Mo., for eye, nose and throat troubles, 41 per cent were in need of glasses, and 7.7 per cent did not hear well, usually in one ear. Of 156 pupils examined in the seven grades of the school of observation connected with the Summer School of the University of Pennsylvania,2 38.5 per cent had decayed teeth, 20.5 per cent suffered from eye strain, 13.5 per cent from nasal obstruction, 5.1 per cent from defective hearing and enlarged tonsils, 4.5 per cent from poor nutrition, and 2 per cent from nervous exhaustion and stoop shoulders.* A survey of a special retarded class of 41 pupils in Philadelphia yielded 48.7 per cent of eye defects, 34 per cent of defective speech, 26.8 per cent nose and throat troubles, 19.5 per cent nervous temperaments, 17 per cent each of orthopedic defects and lack of motor control, and 17 per cent of hearing defects. Nineteen out of twenty school children examined in London had some eye disease.
It is impossible to state under the present rather chaotic conditions of conducting medical school inspection whether these figures exaggerate or minimize the true state of affairs. Some inspectors record only serious affections, others all sorts of minor defects. There is diversity of opinion as to the amount of deviation necessary to constitute sensory defects (e. g., of vision and hearing), or to produce organic abnormalities which require treatment. Thus A. E. Taussig, M.D., maintains that the criterion of defective vision should be a degree of acuity less than 20/30. The same chaotic condition exists with regard to the records. These 1Taussig, Albert E. The Prevalence of Visual and Aural Defects among the Public School Children of St. Louis Co., Mo. The Psychological Clinic, Vol. Ill, No. 6, November 15, 1909.
sCornell, Walter S. The Physical Condition of the School Children of the School of Observation, Univ. of Pa. The Psychological Glinic, Vol. Ill, No. 5, October 15, 1909.
differ from city to city; many give no indication as to which are the principal defects discovered; many do not specify clearly the exact nature of the defects; some group the secondary troubles with the primary, the contagious with the non-contagious physical deviations, the temporary and curable ailments with the non-curable or protracted defects; some give no individual records for visual and auditory acuity in comparative objective measures for each eye and ear separately (although such information is of paramount value to the teacher in enabling her to seat her children judiciously) ; others omit the age, sex, nationality, grade, home, and community conditions of the child (although, such details are of surpassing importance, to enable us to correlate physical effectiveness and disease with age, sex, nationality, and environment) ; and practically all omit reference to the mental condition, disposition, and behavior of the child prior to inspection and treatment, and nearly all lack a “follow-up” form of card on which to record the results of treatment upon the child’s subsequent mental efficiency, disposition, deportment, health!, increase in weight, and physical growth and development. That the latter has received scant if any scientific study is no doubt due to the difficulty of obtaining pedagogical and psychological measures which, shall be objectively and scientifically valid. The classroom registers and the judgments of the teachers surely have their values, but the grading and judgments of the teachers are so variable that to measure the child’s increasing proficiency as the result of treatment in quantitative terms is out of the question. Nevertheless a “follow-up” system of recording the influence of various forms of treatment upon various kinds of defects based upon the teachers’ marks and opinions is infinitely better than no system at all, and is imperatively needed unless we are content to be empiricists in this newly organized community and school work. To develop this work aright we must have accurate knowledge of the influence of various abnormalities and of their treatment upon mental and physical development. Taussig has recently proposed a means of measuring the influence of physical defects upon school work; and the same is applicable as a measure of the effects of treatment. He would calculate the average grade of proficiency for each age for the normal and defective pupils by multiplying the number of children in each grade by the number) of the grade. The average grade can then be secured by dividing the result by the total number of children. This gives an objective measure, but it assumes the accuracy of the teacher’s marks. Unfortunately these are far from infallible. But assuming a fair degree of accuracy for the individual markings, the scheme offers a criterion of general validity for gauging these influences. It ought to be given a fair trial.
But a scheme of supplementing the teacher’s grades and opinions by means of careful psychological tests of the pupil’s quickness of perception, rapidity of association, strength of immediate visual and auditory memory, strength of grip, ability to spell and add, etc., carried out a short time prior to treatment and subsequently at different intervals, will eventually command the attention of medical inspection departments. Such tests are perfectly feasible and will enable us to quantify the influences whose effects upon the working capacity of the pupil we wish to estimate. In an initial plan these tests might well be confined to selected groups of boys and girls.
But to return from this digression to the medical inspection work in Cleveland. The conditions revealed by the volunteer inspections in the schools and the humanitarian work performed by the nurses and physicians in relieving needless physical suffering, which interfered with the working efficiency of both the child and the school, demonstrated to the Board of Education the urgency, on economic, educational, and moral grounds, of establishing as an integral part of the schools a department of medical supervision and inspection. Such a department, under the administrative charge of Director Orr, was put into operation on the first of April. It has at its disposal an annual budget of $30,000. It has in its employ one supervisor at a salary of $3000 per annum (Dr H. G. Sherman, who as chairman of the committee on municipal sanitation of the chamber of commerce did yeoman service in getting the department established), fifteen medical assistants or inspectors at $100 per month for twelve months per year, ten nurses at $60 per month the first year, $70 the second, $75 the third, and $80 thereafter, and one clerk at $1000 per annum. The department contemplates the inspection of all the pupils to determine their state of health and the presence of diseased conditions and physical anomalies. Teachers and parents will receive advice on the diseases and defects found, with, recommendations fori their relief; the pupils and teachers will receive advice on the safeguarding of their health, and suggestions will be offered respecting the course of study, construction of buildings, etc. Records in duplicate will be on file at the schools and the headquarters of the department, and will be sent home to the parents. These records will accompany the child throughout his course in the grades. It is expected that the records will be made unusually complete and accurate. The city will be divided into fifteen districts, comprising about six schools each, with one physician and nurse in charge of each, making each physician responsible for inspecting somewhat less than 5000 children (each of the two hundred inspectors in New York has about 4000 children under his care, while each of Chicago’s one hundred has approximately 6000). By thoroughly inspecting the first year entrants it is believed that the work will be materially lightened in the upper grades. Tree treatment is not a part of the program. The rules and regulations of the department are made by the Board of Education.
II. Opening of the National Campaign on Oral Hygiene Under the Auspices of the National Dental Association,, the Ohio State Dental Society, and the Cleveland Dental Society.
In 1908 the Committee on Education and Hygiene of the Cleveland Dental Society reported a plan for dental education m the public schools of the city, embracing among other matters a course of lectures to be given to the teachers. The plan was censored and criticised by the Dental Society and given scant consideration by the Board of Education. Nothing was accomplished beyond the issuing of a bulletin of information on the care of the teeth by the Superintendent of Schools to the teachers, who were directed to impart the information to the children. Somewhat over a year later a free dental clinic was established at the City Hospital. The venture proved largely unsuccessful, due to the unfavorable location of the clinic. Inspection trips were then made to Boston, New York, Rochester, Birmingham, Ala., and other places for the purpose of studying the methods employed for the dental education of school children. At this juncture Dr. “W”. G. Ebersole, who was chairman of the Cleveland Committee on Education and Hygiene, became chairman of the Oral Hygiene Committee of the National Dental Association. With the oral hygiene headquarters established in Cleveland, and data available from the cities visited, the campaign began afresh. Permission was received from the Board of Education to conduct a dental survey in four representative schools. This survey was made in one day by about forty dentists. The detailed results are embodied in the following table. The table is not absolutely accurate, owing to the haste with which the work had to be done, and the occasional misinterpretation of the instructions by some of the examiners. Thus some examiners; thought that “good,” “fair,” or “bad” referred to the teeth only, and therefore some mouths were marked good when the oral conditions were unhygienic. The results thus rather minimize than overemphasize the actual oral conditions found. The figures from the Marion school are the most accurate.
Murray Hill. Doan. Waterson. Marion. Total Number of Pupils Examined. Condition of the Mouth: Good Fair Bad Condition of the Gums: Good Bad Use Tooth Brush: Yes No Teeth Filled: Yes No Mal-occlusion: Yes No Teeth containing Cavities. Teeth Extracted Nationality: American… German…. English Italian Russian Slavish. Bohemian., Swedish…. Irish French Norwegian. Polish 864 346 381 134 594 253 101 762 9 843 230 633 25 4 4 828 1 1 691 132 429 117 504 169 524 161 275 404 421 452 641 69 657 1 298 135 99 63 221 73 193 100 102 191 93 169 257 14 198 20 45 7 824 244 336 241 447 300 243 456 72 707 343 308 745 125 116 73 11 420 2677
Number of Perfect Mouths Number of Defective Mouths… Number of Cavities 62? 7.17% 802?92.83% 3920 20? 2.9% 671?97.1% 4294 14? 4.69% 284?95.31% 1342 9 49 13? 1.5’ 811?98.43% 5505
The 2677 mouths examined contained 15,061 dental cavities, or an average per month of 5.6 (somewhat above the Worcester average, 4.85) ; in 2145 mouths, or in about 80 per cent, the teeth were not filled; mal-occlusion affected 1087, or somewhat over 40 per cent; in 1479, or 55 per cent, a tooth brush,?the instrument that is mightier than the sword in national eugenics,?was never used; the number of defective mouths ranged from 92 per cent to 98 per cent; and practically 97 per cent of the oral cavities required some sort of hygienic attention or dental service, to render the mouth healthy and functionally efficient. As will be seen in the table, some of the defects are most prevalent in the schools with a preponderant Italian population?an indication of the relation of unwholesome environmental influences and unenlightened or poverty-stricken conditions in the home to unsanitary oral conditions. It will be of interest to recount some of the results of dental surveys in other cities. One of the first, if not actually the first, inspection was made in Russia in 1879. Defective dentures afflicted 80 per cent of the inhabitants of St. Petersburg. Of Berlin school children, 90 per cent were similarly affected (Hitter), and of 100,000 school children examined in different states of Germany, from 81 per cent to 99 per cent had diseased teeth. In Ludlow, Mass., the 500 pupils examined (from eight to fifteen years old) displayed palpable neglect of dental cleanliness, very few used brushes, none had received any dental treatment beyond a few instances in which teeth had been extracted, bacterial deposits and malodorousness existed in varying degrees, some suffered from prolonged retention of the temporary teeth, while still more had lost these teeth prematurely, showing a disregard of the value of the temporary teeth. In New York an expert examination was made of the teeth of 500 boys and girls from fourteen to sixteen who were applying for work certificates, on behalf of Children’s Aid Society. Less than 3 per cent of these had sound teeth; 456, had 2808 decayed teeth, or an average of about 6.1 each, 90 per cent of which could be saved by proper dental attention. Gangrenous pulps, or decayed pulps exposing the roots, were found in 247 boys and 152 girls; and only 25 out of the 500 had received any dental care other than extraction. In an early inspection of all the pupils in Cleveland by the ward physicians under the direction of the Board of Health, 79 per cent of the children suffered from decayed or defective teeth. With such distressing revelations as these it is little wonder that experts have come to regard caries of the teeth as the “disease of the people,” a world-wide affliction of civilized nations, and the unsanitary mouth, which is the gateway to the stomach, as the body’s chief breeding place for pathogenic bacteria, a hidden source of infection little attended to because of its hidden character. And with these revelations the modern propagandist of the body hygienic has rallied his forces about a new battle-cry: “Keep the mouth with diligence, for out of it are the issues of life.” “Good teeth, good health”?is the modern orthogenic tocsin. In no branch of public hygiene are such decisive results obtained and with such small cost.
The results of the Cleveland survey induced the Board of Education, in October, 1909, to grant the request of the National Dental Association, the Ohio Dental Society, and the Cleveland Dental Society, to conduct dental examinations of all the pupils in the public schools during a period of one year, to treat gratuitously all indigent children so desiring, and to offer lectures in the school buildings to teachers, parents and pupils on the proper care and use of the teeth and mouth. On March 18, 1910, the formal opening of these clinics?four in public schools, and one each in St. Alexis Hospital and the City Clinic?was signalized by a convention in Cleveland, at which addresses were made by the President of the National Dental Association, the Chairman of the Education and Oral Hygiene Committee of the Ohio State Dental Society, the Chairman of the Oral Hygiene Committee of the National Dental Association, the Commissioner of Health of Chicago, the Superintendent of Schools of Cleveland, the Dental Surgeon of the Naval Academy, the Mayor of Cleveland, the personal representatives of President Taft and Governor Harmon, and others. The exercises included the formal dedication of the clinics and addresses on various aspects of dental school inspection. The convention marked the inauguration of a country-wide campaign for the organization of departments of dental inspection as integral parts of the public school systems of our cities. It is expected that one year of volunteer work in Cleveland will demonstrate the importance of the work, as one of the worthiest and noblest undertakings of the schools, whether from an altruistic, educational or economic point of view. Special scholarship and deportment blanks will be kept on which records of the treatment will be made and of its effect upon the subsequent working efficiency and behavior of the child. It is planned toconduct a few of the simpler psychological tests upon quickness of perception and association, the visual and auditory memory span, and ability to add, both before and subsequent to treatment, in order to measure objectively and under control conditions the effects of the corrective treatment upon various mental operations. Other blanks in triplicate will be furnished to the Director of Schools, the Cleveland Dental Society, and one to the pupil or teacher for the parent. Parents who desire treatment for their children on the ground of poverty must make application upon a separate “indigent” blank. The clinic patient will be supplied gratis with a brush, tooth powder, antiseptic wash, plastic (not gold) fillings, and pulp and root treatments. The examiners and clinicians will be certified and assigned to their respective schools by the Director of Schools and the Supervisor of Dental Inspection. Permanent clinicians will probably be secured. The material equipment of the clinics is furnished by the National and Ohio Dental Associations, and the dentists and assistants (each examiner will have a woman assistant) by the Cleveland Dental Society. Each examiner will donate one week’s services, or twelve half days. The lecture course will be in the hands of twenty men. The cash equivalent to the Cleveland Society amounts to about $3491.00,?$1866 for examination work, $1500 for clinic work, and $125 for the lecture and educational work.
Thus the year 1910 marks the introduction upon a volunteer basis of the first dental school clinic in the United States, six years after the first dental school clinic was established in Strassburg by Dr Jessen. This clinic is open to all school children without charge, and is manned by regularly registered dentists under municipal control. School clinics of the same type have since been established in thirty-five or more German cities. With the better understanding which we now have of the effects of the unhygienic oral cavity upon the health, happiness, mental and physical efficiency, and the morals of the child, it is predicted that the spread of the dental school clinic will be no less rapid in our own country. It is reported of a certain juvenile judge that he always has the teeth of his youthful culprits examined before he imposes sentence; and not infrequently the penalty imposed is a trip to the dental chair. Match manufacturers subject their employees to dental inspection and exclude all persons with decayed teeth. Phosphorous necrosis has thus disappeared among match workers. Some hidden cavity in a tooth or unclean surface is often a focus for latent bacteria. Such foci serve as the breeding places of acute infections, of scarlet fever, diphtheria, and tuberculosis, and enlargements of the glands of the neck and throat may occur through absorptions from these cavities. The gases and poisons generated in an unsanitary mouth and the pain from toothache often produce general and gastric neurasthenia, indigestion, ill health, irritability, bad temper, mental inefficiency, inability to concentrate attention, bad morals, and even insanity. The machinery for discovering these conditions in the schools? the only organized social agency with anything like police power? “Will come inevitably. Will we get the machinery for rectifying these conditions, tlie dental school clinic in addition to the dental school inspection station ? Whether or not compulsory school clinics are desirable, some form of pressure cannot be dispensed with if this work is to realize proper returns upon the investment. In one of the German cities such pressure is secured by barring children with diseased teeth from the privileges of the recreation grounds, forest school and vacation colonies.
“Without good teeth there cannot be thorough mastication. Without thorough mastication there cannot be perfect digestion. Without perfect digestion there cannot be proper assimilation. Without assimilation there cannot be nutrition. Without nutrition there cannot be health.” And it might be added, without the retention of the teeth there cannot be beauty of countenance.
REFERENCES.
Ayres, L. P. The Effect of Physical Defects on School Progress. The Psychological Clinic, Vol. Ill, No. 3, May, 1909, p. 71. Cornell, Walter S. The Relation of Physical to Mental Defect in School Children. The Psychological Clinic, Vol. I, No. 9, February, 1908, p. 231. , . Mentally Defective Children in the Public Schools. The Psychological Clinic, Vol. II, No. 3, May, 1908, p. 75. , . The Physical Condition of the School Children of the School of Observation, University of Pennsylvania. The Psychological Clinic, Vol. Ill, No. 5, October, 1909, p. 134. The Need of Improved Records of the Physical Condition of School Children. The Psychological Clinic, Vol. Ill, No. 6, November, 1909, p. 161. Ebersole. Report on the Proposed Dental Educational and Hygienic Work in the Cleveland Schools. Dental Summary, February and March, 1910 (reprinted in the Dental Brief and Dental Digest, same issue). Elson, W. H. Annual Report of the Superintendent of Schools, Board of Education, Cleveland, O., 1907, p. 38. Emery, Medical Inspection in Two Worcester Schools. The Pedagogical Seminary, Vol. XVII, No. 2, April, 1910, p. 111. Greene, Mary Belle. A Class of Backward and Defective Children. The Psychological Clinic, Vol. Ill, No. 5, October, 1910, p. 125. Holmes, Arthur. Can Impacted Teeth cause Moral Delinquency? The Psychological Clinic, Vol. IV, No. 1, March, 1910, p. 19. McHenry. Medical School Inspection in Cleveland. The Cleveland Medical Journal, Vol. VIII, 1909, p. 338. Orr. The New Medical Inspection Department in the Cleveland Public School. The Cleveland Sunday Leader, Magazine and Workers’ Section, March 13, 1910. Sneed, C. M., and Whipple, G. M. An Examination of the Eyes, Ears, and Throats of Children in the Public Schools of Jefferson City, Mo. The Psychological Clinic, Vol. II, No. 8, January, 1909, p. 234. Taussig, A. E. The Prevalence of Visual and Aural Defects among the Public School Children of St. Louis County, Mo. The Psychological Clinic, Vol. Ill, No. 6, November, 1909, p. 149. Wallin, J. E. W. Medical and Psychological Inspection of School Children. The Western Journal of Education (Ypsilanti, Mich.), Vol. II, 1909, p. 433.
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.