Part 2 (1/2)

[Ill.u.s.tration: The equipment of the Marion School dental clinic cost about $700.]

When this work started, it was frankly an experiment. Through wise and thoughtful management the Mouth Hygiene a.s.sociation has shown that dental clinics for school children are both practical and necessary.

This having been demonstrated, the time has come when the city should take over their direction. Cleveland should no longer rely upon the activity of a private organization, but at an early date should a.s.sume full financial and administrative responsibility for dental clinics in the public schools.

Dr. William Osler, the distinguished English physician, is credited with saying, ”If I were asked to say whether more physical deterioration was produced by alcohol or by defective teeth, I should say unhesitatingly, defective teeth.” The development of the movement for dental inspection of school children in Cleveland shows that the educational system has been awakening to a realization of the truth and significance of Dr. Osler's statement. The most salient fact in the situation is that the commonest of all physical defects among school children is decayed teeth. Cases of dental defectiveness are frequently greater in number than are all other sorts of physical defects combined. Moreover, it is probably true that there is no single ailment of school children which is directly or indirectly responsible for so great an amount of misery, disease, and mental and physical handicap. These are reasons why Cleveland should steadfastly continue in the maintenance and development of the dental clinics.

EYE CLINICS

An eye clinic is maintained by the Department of Medical Inspection at the Brownell School. This clinic is open every afternoon during the school year. The method of procedure is as follows: During the routine physical examinations of children by the doctors in the different schools, the vision is tested and, if found defective, the parents are advised of it by note. The nurse then follows up the case and if she finds that the parents are unable to pay for an examination by an oculist, she takes the child to the school clinic, after having obtained the written consent of the parent. There the child is given a thorough and accurate examination, the eyes being first dilated with homatropin and the error of refraction determined by means of the retinoscope. The proper gla.s.ses are ordered for the child and in a few days he is brought back to the clinic and the frames carefully adjusted. The nurse then keeps in touch with the case, seeing to it that the child wears the gla.s.ses, that the frames are straight, and that the symptoms of which the child complained are relieved.

[Ill.u.s.tration: The eye clinic is advertised by its loving friends.]

Many parents are unable to pay an oculist's fee but are able and willing to pay a small amount for gla.s.ses and in these cases a nominal charge is made for them. Experience has shown that if a charge, no matter how small, is made for the gla.s.ses better care is taken of them and better results are obtained. In some cases there has been opposition on the part of the parents to the child's wearing gla.s.ses, but usually the nurse has been able to prove to them the necessity and has obtained their consent.

During the school year 1914-15, the total number of dispensary visits was 1,913. In 665 cases the eyes were refracted and in 500 cases gla.s.ses were furnished. In about 75 per cent of the cases the children's symptoms are relieved and their scholars.h.i.+p is improved. In about 10 per cent of the cases the symptoms are not relieved. About five per cent of the children refuse to wear the gla.s.ses. The remaining 10 per cent of the children cannot be located because they have moved from the city or been transferred to private schools. The value of the work of the eye clinic is beyond question.

There are no other clinics in connection with the Cleveland public school system. Mental examinations are made by a special teacher appointed for that purpose. All surgical cases are referred to family physicians or local hospitals for treatment.

CO-OPERATION OF COLLEGE FOR BARBERS

Rather an unusual form of clinical work is found in service rendered by students of the Cleveland College for Barbers. In several districts an arrangement between the school physician and the college provides that free hair cuts be furnished pupils at intervals during the school year. The coming of the barber is an event eagerly greeted, and princ.i.p.als report that as a result children show increased pride in personal appearance.

THE MEDICAL INSPECTION STAFF

The organization of the staff deserves special comment. The physicians employed are mature men, graduates of well-known medical schools. The youngest medical inspector on the staff is 29, the oldest 46, and the average age of all the doctors is 36. They are picked men, selected for the work because of their skill, intelligence, and social viewpoint. They are splendidly representative of the medical profession in Cleveland. They have fairly wide private practices and in many cases are carrying on the school work at real financial sacrifice because of their interest in the problems it involves. Their a.s.sistants are all registered nurses from the Visiting Nurses a.s.sociation and distinctly high grade women.

Medical inspectors receive $100 a month during the school year. They are required to give three and one-half hours a day, five days a week, to work in the schools, inclusive of traveling time between buildings.

Nurses are paid on the schedule of the Visiting Nurses a.s.sociation and salaries range from $60 to $80 depending upon length of service. The upper limit will probably be raised to $85 in the near future. Nurses are on duty from 8:30 to 4:30 every weekday except Sat.u.r.day, when work ends at noon. Nurses are regularly employed only during the school year, but two are retained longer for service in summer schools.

The efficiency of doctors and nurses is in no small measure due to the frequent informal conferences of the staff. In addition to many smaller conferences, once each month the entire staff meets--nurses as well as physicians--to discuss problems which have arisen during the preceding weeks, and makes plans for the future. These meetings are very informal; nurses are urged to take part in the discussion, and the result is the enthusiastic co-operation of the entire staff.

THE PLAN OF CONCENTRATING INTERESTS

An interesting feature of organization is the plan whereby each year a different series of problems is attacked, and the energies of the entire staff directed along this line. Thus, 1910-1911 shows special emphasis laid upon eye defects, and nearly 11,000 children were found in need of gla.s.ses. In 1911-1912, although the number of defects discovered increased, the number of children examined strikingly decreased. Extra study was made of adenoids, glands, nutrition, and goitre. The following year less emphasis was laid on discovering defects and the entire staff united in an effort toward correcting those already noted. Practically every child in the system was examined. At the same time one member specialized on hunting for tuberculosis cases and another on mental examinations of backward children.

In 1913-1914, the force was especially interested in the question of communicable disease and the proportion of conjunctivitis, ring worm, impetigo, scabies, and pediculosis discovered and treated was very large. As a natural accompaniment of this activity, the number of home visits and school treatments decidedly increased. In addition, there was a notable rise in the frequency with which parents came to the dispensary for conferences with the doctor about their children.

The record for 1914-1915 shows a decrease in the number of home visits, which is partly accounted for by the fact that the number of dispensary visits made by nurses has practically doubled. The number of parent consultations with doctors has increased by one-half the record for 1914, and in contrast with 500 health talks given to cla.s.ses by nurses last year, we have 1,260 talks by physicians and 4,431 by nurses to cla.s.ses in 1914-1915.

This method of varied problems is unquestionably effective in promoting growth and maintaining interest on the part of the staff.