Health Conditions of School Children too Serious to be Neglected
NEWS AND COMMENTS.
The 1917 budget estimate of the Bureau of Child Hygiene of the Health Department of New York City calls for $75,240 more than last year for school health work. The additional money is needed for enlarging the staff of medical inspectors and nurses, so as to reduce the present proportion in the number of children to physician and nurse to a better working basis. Six dental hygienists are also asked for who are to be engaged in prophylactic work and giving surface treatment, thereby adding considerably to the preventive as well as curative services at present available in the schools and clinics. The following table shows the present and proposed staffs:
1916 1917 Increase Medical Inspectors 100 125 25 School Nurses 200 252 52 Dental Hygienists 6 6 NEWS AND COMMENT. 177 The 1915 reports on medical inspection show that out of over 925,000 pupils enrolled in the public and parochial schools, only 305,665 or 33 per cent were examined for physical defects, leaving a large percentage among the two-thirds of the enrolled children not examined possibly suffering from various physical defects, which in their very nature are a handicap to school progress. Of the children examined, 222,072 or 72.6 per cent had physical defects requiring treatment as follows: defective vision, 14.5 per cent; defective nasal breathing, 9.5 per cent; hypertrophied tonsils, 11.2 per cent; defective nutrition, 5.3 per cent; defective teeth, 63.9 per cent; and to a lesser extent there were cases of cardiac and pulmonary diseases, defective hearing and orthopedic defects.
The large number to be examined and the small staff of physicians available made it impossible at times to give each child a complete physical examination, with the result that 129,125 or 42.2 per cent of the children examined did not have their vision tested. The large percentage of unterminated cases under treatment or investigation proves the insufficiency of the staff employed for this vast and important task. As much of the curative work done by private physicians or at clinics is due largely to the follow up efforts of the school nurses, this phase of the health supervision cannot be conducted as effectively as desired unless an adequate staff of nurses is provided. Both these handicaps in the results of the year’s work are due to the large number of pupils assigned to each physician and nurse, being respectively 9200 and 4800, whereas the ratio should never exceed 3000 in either case. The appointment of the additional physicians and nurses asked for will reduce but slightly this ratio: 1916 1917 Pupils to physician 9200 7400 Pupils to nurse 4800 3666 Public safety demands the quick recognition and exclusion from school of all cases of infectious disease. The health and efficiency of each individual child demand the discovery of any physical defects which may have a deleterious effect, not only on his well-being but also on his educational progress. Without the proper number of physicians and nurses indicated above, neither of these important requisites can be observed. The welfare of the community as well as the interests of our educational and health systems are sufficient grounds on which to urge the granting of the increased appropriation asked by the Health Department.
Under the Education Law of the State of New York the employment of physicians to examine each public school child each year is made mandatory outside of New York City. Under the present system in New York City each child is examined but once in three years during its school life. The cities of Boston and Philadelphia, where social and economic conditions affecting school children are analagous to those in New York, are governed by the laws of the States of Massachusetts and Pennsylvania, respectively, which make annual examinations of school children mandatory. Similar statutory provisions are in force in the States of Maine, Minnesota, North Dakota, Rhode Island, Utah and West Virginia. If we cannot insure the annual examination of each child attending school in New York City and the effective following up of each case found needing medical attention, the city should at least provide for the thorough examination and following up of a larger percentage of children than it is at present possible to reach.
The school nurse plays a highly important part in our school health supervision. Her duties are many and extend beyond the school building. The efforts of the medical inspectors would be of little avail without the following up of the cases by the nurses. Upon the school nurse devolves the highly important duty of examining the children for contagious diseases. This work consumes a great part of the nurse’s time and is in its very nature an exacting procedure. Adding to this the follow up work with its many home visits, taking children to dispensaries for treatment, and the numerous cases requiring emergency treatment which turn up daily in every school, it will readily be seen that the present staff of nurses is insufficient and that the individual nurse is overtaxed. The number of children cured of serious physical defects thus depends largely on the number of parents receiving the advice and aid of the school nurse. This activity is necessarily limited by reason of the small number of nurses assigned to this work, with the result that large numbers of cases are never reached, often with very serious consequences.
For the first time in the existence of the system of medical inspection in New York City, funds ai;e requested for the employment of dental hygienists. The experience of Bridgeport, Connecticut, and other cities employing dental hygienists has demonstrated the great value of their services as well as the considerable economy affected thereby. Instruction in the care of the teeth, which at present is an added burden to the many other duties of the school nurses, and the cleaning of children’s teeth, which is seldom done in the clinics, can be done expeditiously and satisfactorily by dental hygienists, especially trained in these branches of dental practice. The large percentage (63.9 per cent) of children with defective teeth in the public schools and also the fact that more than half of these children are probably too poor to patronize private dentists, offer the most convincing proofs of the need for such prophylactic treatment being made easily and continuously available to the children in our schools. Charles C. Burlingham, Chairman,
Bureau of Welfare of School Children.
Feeding New York’s School Children.
In the May, 1916, number of The Modern Hospital, Miss Elizabeth M. Fee, supervisor of the New York School Lunch Committee, published a very interesting report upon the progress of the work in 1915-16. “The failure to provide a nourishing noonday meal for children,” she is convinced, “accounts in part for the large percentage of malnutrition cases found by the medical inspectors in the schools. During the past year 16,181 cases of malnutrition were reported in the schools of New York City. In 1909, when the system of medical inspection was newly organized, and the first general physical examination of the children in the schools was in progress, the report that 7,249 children out of 231,081 examined were found to be malnourished startled the public and caused the press to engage in a discussion of the social and economic conditions which cause so many children to suffer from poor nourishment. “As a result of this disclosure, the New York School Lunch Committee was organized under the leadership of Miss Mabel H. Kittredge, who is still active in that capacity. The work of this committee found favor with the public, and won the approval of the school authorities. The popularity of the school lunch grew so rapidly that a large number of schools which were not so equipped requested the installation of lunch services. Eventually the committee became affiliated with the New York Association for Improving the Condition of the Poor, as a part of the Department of Social Welfare. Thus greater resources and facilities came within the control of the committee and its activities were greatly increased, being at present more than six times as extensive as they were when the committee originally took up the work. “Last year the committee operated lunch services in 19 public schools, with an aggregate enrollment of almost 27,000 pupils. A total of 1,488,527 portions of food were sold to the children, the returns for which amounted to $14,885.27. This sum of money repaid the cost of the food, the committee bearing a deficit for the cost of service.
“The equipment of kitchens and the various accessories are provided in part by the Board of Education. The Board of Estimate and Apportionment has voted a special bond issue of $26,000 for the equipment of school kitchens and lunch rooms. This will enable the committee to extend its service to about 60 schools.
“The daily menus in the schools vary, and the children are offered a large choice of desserts, in addition to the soup and the other staples, such as sandwiches and salads. Attention is also given to the preferences of children of different nationalities. In the Italian section Italian cooks are in charge of the school kitchens, and foods familiar to this nationality are served. In the Jewish sections Jewish cooks are employed who are familiar with the dietary regulations of the orthodox law… .
“In many families the mothers are working either in factories or doing piece work at home, and consequently have no time to spare in preparation of lunches. If the children had not the advantage of a hot, nourishing luncheon in school, they would have to go through the entire day on merely a cup of coffee with dry bread, or several dill pickles.
“The work of the School Lunch Committee is not in the nature of charity relief. The aim is to provide nourishing food to the children of the poor as well as those in comfortable circumstances at cost. Nevertheless, the lunch service has afforded opportunity to reach into the homes of indigent families who were not recipients of charity and yet deserved such assistance as it was possible to secure for them.”
The Indian no longer a Vanishing Race.
At the Mohonk Conference at Mohonk Lake, New York, October 18, 1916, an address was delivered by Dr Lawrence W. White, Superintendent Lac du Flambeau (Wis.) Indian School, in which he said in part: Three years ago everyone had accepted the apparent fact that the Indian had passed into a state of decadence and the death of the race was imminent, when the present Commis180 THE PSYCHOLOGICAL CLINIC sioner of Indian Affairs, Mr. Cato Sells, faced the condition squarely and said, “To discover such a condition and not correct it were criminal… . We cannot solve the Indian problem without Indians. We cannot educate their children unless they are kept alive.”
In compliance with the policy outlined by the Commissioner, superintendents began more thoroughly to acquaint themselves with the home conditions of the Indians on their reservations, with the object in view of eliminating, as far as possible, everything that retarded the improvement of health conditions. Physicians were started on systematic sanitary inspections. Appreciating the value of good teeth in relation to good health, an effort was made to provide dental facilities for the Indians through a corps of travelling dentists. The demands upon their services are so great that no doubt remains with respect to the appreciation of the Indians for this form of treatment. As funds permit, it is hoped to increase this service more adequately to meet the demands upbn it. The trained nurse was called upon to care for the sick. The field matron, the farmer, the teacher, in fact every field employee was soon enlisted in a campaign to restore the constitution, to regain the health, to save a race that had by competent persons been proclaimed to be dying. Baby Shows have become a part of every Indian fair, Baby Weeks and Child Welfare Exhibits have been carried out on nearly every reservation in the Indian country. Mothers’ Meetings have been instituted, Little Mothers’ Leagues formed, and other educational features have been made a part of this campaign with the idea of teaching the Indian mothers the proper way of caring for their children.
In 1912 the medical force of the Indian Service consisted of: 1 Medical Supervisor, 1 Assistant Physician, 2 Opthalmologists, 89 Agency Physicians, 1 Physician Expert, 53 Contract Physicians. This force has been increased until now it consists of: 3 Medical Supervisors, 76 Contract Physicians, 7 Opthalmologists, 7 Field Dentists, 130 Agency Physicians, 6 Field Nurses. In addition there are also substantial increases in the number of hospital nurses, field matrons and miscellaneous hospital employees.
The general health appropriation for relieving distress and prevention of diseases among Indians to be requested for the year 1918 will be $400,000. The amount used for this purpose has been multiplied by ten during the last eight years, the larger part of the multiplication having occurred in the past three years, and the results obtained have more than justified the expenditure. Attention was called to vital statistics for 1916 which have been collected by states and are accurate, but exclude the Five Civilized Tribes and certain unattached Indians of California, data upon which is not at present available: Total Indian Population 209,224 Total births 6,092 Total deaths 4,570 Excess of births over deaths 1,522
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