Denial Hygienists
NEWS AND COMMENT.
A monograph of the Department of Health of the City of New York states that it is safe to assume that not less than 90 per cent (832,500) of school children of the city are in need of dental treatment. It may be said that this situation is due to imperfect tooth structure, the causes of which lie partly at least in prenatal malhygiene, improper feeding of children, lack of cleansing, and neglect to prevent progressive decay by early professional treatment. The insidious character of tooth decay and disease is becoming increasingly apparent from the scientific relationships being drawn between oral malhygiene and disease. There are hardly enough licensed dentists to repair the dental ills of the school population alone. This situation, engaging the attention of school hygienists, has directed attention to new means of attacking this problem. It was apparent that little was to be expected from curative channels in any effective program of action. Prevention is the keynote of modern health work. Inasmuch as the prophylactic principles of dentistry are defined, it was patent that the solution lay in this direction.
For some time Dr Alfred C. Fones of Bridgeport had been successfully experimenting in the use of so-called “dental hygienists” or specially trained women who give surface treatment to the teeth of school children. Last spring Dr Philip Van Ingen, chairman of the Committee on Child Hygiene of the Advisory Council of the Health Department of New York, in conference with the Health Commissioner appointed a committee to study, report and recommend as to the desirability of utilizing dental hygienists in New York. The Committee held a number of meetings, and on February S, 1916, submitted the following unanimously:
“The sub-committee on dental hygienists held three meetings, at which time the question of dental hygienists was thoroughly discussed. The committee now begs leave respectfully to report that a trial of surface cleansing of teeth of school children with accompanying instruction in oral hygiene be commenced at the earliest possible moment in one or more centers, preferably public schools, provided that the work be done by specially and adequately trained persons and under the supervision of competent directors.” On February 17, 1916, the whole Committee on Child Hygiene of the Advisory Council ratified the report and recommendations of the sub-committee. Dr Haven Emerson, Commissioner of Health, has evidenced the keenest interest in this work and it appears probable that at an early date some nurses will be assigned to this work.
At one time there appeared to be some question as to the legality of employing dental hygienists. The question was submitted to the Corporation Counsel by the Health Commissioner who reported that there is nothing in the dental law to prevent the use of dental hygienists. In order, however, to avoid any possibility of untrained persons entering upon the work without proper legal safeguards to prevent fraud, inefficiency, and exploitation, there has been introduced in the legislature a bill (Senate Bill No. 391) the provisions of which on this subject are as follows:
“Any dental dispensary or infirmary legally incorporated and registered by the regents, and maintaining a proper standard and equipment may establish a course of study in oral hygiene. All students upon entrance shall present evidence of attendance of one year in the high school, and may be graduated in one year as dental hygienists, upon complying with the preliminary requirements to examination by the board, which are:
“A. A fee of five dollars.
“B. Evidence that they are twenty years of age, a legal resident of the state of New York and of good moral character. “C. That they have complied with and fulfilled the preliminary and professional requirements and the requirements of the statute. “After having satisfactorily passed such examination they shall be registered and licensed as dental hygienists by the regents under such rules as the regents shall prescribe. v
“Any licensed dentist, public institution, or school authorities may employ such licensed and registered dental hygienists. Such dental hygienists may remove lime deposits, accretions and stains from the exposed surfaces of the teeth, but shall not perform any other operation on the teeth or tissues of the mouth. They may operate in the office of any licensed dentist, or in any public institution or in the schools under the general direction or supervision of a licensed dentist, but nothing herein shall be construed as authorizing any dental hygienist performing any operation in the mouth without supervision. The regents may revoke the license of any licensed dentist who shall permit any dental hygienist operating under his supervision to perform any operation other than that permitted under the provisions of this section.” With these progressive steps taken, it is to be hoped that through prevention we will preclude the possibility of another generation of children growing up, 90 per cent of whom will be exposed to the havoc wrought by diseased and rotting teeth.
Edward F. Brown, Secretary Dental Group, Advisory Council, Committee on Child Hygiene, New York City Health Dept.
Wassermann Reactions of Juvenile Delinquents.
The Bureau of Juvenile Research of Columbus, Ohio, has done a good piece of investigation in testing the blood of 365 juvenile delinquents by means of the Wassermann reaction. The report is presented by Dr Thomas II. Haines, in the Journal of the American Medical Association for January 8, 1916. Dr. Walter A. Noble, of the Bureau of Juvenile Research, collected the blood specimens and also made the general physical examinations. Dr Walter McKay, assistant physician of the Institution for Feebleminded at Columbus, made the Wassermann tests. Of the children tested, 147 were in the Boys’ Industrial School, and 218 in the Girls’ Industrial Home; 34 boys and 42 girls gave positive or doubtful reactions. Nine of these boys and 20 girls were tested twice, and 8 girls were tested three times to confirm the diagnosis.
“In regard to the social status of these individuals,” Dr Haines says, “they were all cases committed to reform schools because of delinquencies of various sorts… . The distribution of offences in this group of delinquents yielding positive Wassermann reactions is not in any wise different from the distribution of these offences among the total number of admissions to these reform schools. The same may be said concerning the ages.”
Dr Haines touches a very weak point in the system of medical and social care of delinquent children when he says, “It is required by law that every person committed to a reform school shall have been examined by a physician, and be accompanied by a medical certificate.” But out of 33 girls who yielded positive or doubtful Wassermann reactions, 13 had been “certified as being in good health. A physician’s O.K. is put on each one of these 13 cases. In four cases vision is certified as impaired… . Out of 33 cases,” continues Dr Haines, “in which the Wasserrfiann tests yielded definite evidence of syphilitic infection, only one girl is known to have had syphilis, one is thought to have had symptoms of the primary stage of syphilis, and in four cases there is question of venereal disorder… . This is certainly striking evidence both of the value of the Wassermann reaction in the study of such institution cases, and of the imperative need for its use. This value and this need are both in the service of the individual and for social protection. In no institution case should the person be allowed to go at large until the positive reaction has been changed to a negative.”
After discussing the reflexes and other signs, Dr Haines remarks, “It seems fiom these facts concerning the ages of the girls in question and the complaints on which they were sent to the reform schools, to be highly probable that many of these cases of syphilitic infection are acquired… . These girls have exposed themselves to such infection.” But he cites a case of father and daughter, both feebleminded, with criminal tendencies and bad ancestry, who both yielded negative Wassermann reactions. “The possibility of immunity from syphilis,” he comments, “must have consideration in these cases. This family certainly suggests the need of caution in attributing etiologic significance to syphilis in cases of feeblemindedness.” Indeed the close correspondence of the proportion of defective mental status in cases yielding positive reactions “to that of all persons coming to these institutions, seems to exclude congenital syphilis as a cause or associated cause of feeblemindedness,” but Dr Haines adds, “The question must be left an open one.” Cooperative work, he believes, “between clinicians, laboratory workers, and field workers, in institution cases, should clear up some of these mooted questions.”
Everychild versus Lockstep Schooling.
The faculty of the San Francisco State Normal School, under the leadership of their president, Mr. Frederic Burk, have worked out a plan of individual instruction by which the wrongs inflicted upon “Everychild, a minor,” by the old lockstep schooling are to be redressed. The plan is not a mere figment of an idealist’s brain. It “has been in operation,” we are told, “in the elementary department (first to eighth grades) of the San Francisco State Normal School for the past two years. Records of progress of each pupil have been kept and compiled.” From these data the materials for a monograph of seventy pages have been drawn.
With much originality, this monograph presents its conclusions first. They are in brief:
I. “That the slowest pupils, in normal health of body and mind, will complete the usual eight grades of the elementary school in not more than seven years; that the fastest will finish in not more than five years.” II. “Practically all pupils will complete the course before they reach the ages at which they at present seek to leave the schools.” III. “That the individual system … does in fact give a thoroughness and efficiency to every pupil quite beyond any possibility of the lockstep schooling.” IV. “Individual instruction costs less than class instruction,” by eliminating “the huge wastes inherent in the lockstep.”
V. “The size of classes of 40 to 50 pupils will be automatically reduced to 25 to 30 under individual instruction which eliminates the repeaters, introduces acceleration, and economizes time in other ways.”
This monograph is the sequel to one issued in the fall of 1913 under the title, “Lockstep Schooling and a Remedy.” “To this condition as a chief cause,” observes Mr. Burk, “was traced the retardation by which between 30 and 50 per cent of all pupils now in the schools of the United States have lost one, two, three and more years. To this condition was also traced the chief cause of the fact that over 60 per cent of all pupils in the United States leave school before they have completed the elementary grades, and are ushered into the struggle of life without the rudiments of education.”
The elementary department of the normal school “has been attended by 500 to 600 children ranging from 6 to 16 years of age. Distinctly subnormal pupils,” President Burk explains, “are not admitted, and in all statements it must be understood their absence is assumed.” What has been done “during the past two years has been to determine the actual variation in the rates of progress of pupils when each pupil is permitted to learn at his own rate; to compile exercise books in the several school subjects; to make individual instruction in general practicable; and to invent and put into successful operation an administrative system under the special conditions of normal training schools.”
“The devising of an administrative plan for city schools can only be worked out in a city school,” but Mr. Burk has shown that “it can be accomplished, financially, with saving to the school treasury… . With trained and permanent teachers the problem of inventing an administrative system for individual instruction is new, but it certainly can not be difficult… . The adaptation of texts to make length of lessons elastically fit different pupils, promotion in each subject separately, the establishment of grade standards upon the basis of the slowest diligent pupil’s rate of progress, and the adaptation of a report card to show the individual facts truthfully, constitute the chief mechanical devices for the operation of an individual system.” Educators who wish to know more about this remarkably progressive, humane, and yet economical development in school management, are referred to President Frederic Burk, San Francisco State Normal School, for a copy of the present and earlier monographs. The school also publishes a series of teachers’ manuals and pupils’ exercise books, and a ” Pupils’ self-instruction series adapted to the individual method of teaching.”
New Journals in the Field of Delinquency.
From the Department of Research of the Wliittier State School, Whittier, California, comes the first number of the Journal of Delinquency, “devoted to the scientific study of problems related to social conduct.” The managing editor is Mr. J. Harold Williams, Director of Research at Whittier, and the associate editors are Dr Arnold Gesell, Dr H. H. Goddard, Dr Thomas H. Haines, Dr. William Healy, and Professor Lewis M. Terman. Mr. Fred C. Nelles, Superintendent of the Whittier State School, contributes an introductory statement in which he says, “The harmonizing of juvenile research with clean-cut administrative ideas is the chief problem before us today. It is hoped that the Journal will prove of service in the exchange of ideas which have resulted from careful work.”
Another new magazine with the title, “Crime and Punishment,” has recently been launched in New York City.
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