[16]The technic and principles of municipal engineering have been treated in detail inPrinciples of Sanitary Science and the Public Health, by William T. Sedgwick, and inMunicipal Sanitation in the United States, by Charles N. Chapin, M.D.
[16]The technic and principles of municipal engineering have been treated in detail inPrinciples of Sanitary Science and the Public Health, by William T. Sedgwick, and inMunicipal Sanitation in the United States, by Charles N. Chapin, M.D.
For every school-teacher or school physician responsible for the welfare of children at school, there are fifty or more parents responsible for the physical welfare of children at home. Therefore it is all important for parents to know how to read the index for their own children, for their children's associates, and for their community. School reports and health reports should tell clearly and completely the story of the school child's physical needs.
Necessary To Efficient DemocracyNECESSARY TO EFFICIENT DEMOCRACY
NECESSARY TO EFFICIENT DEMOCRACY
It is impracticable at the present time to expect a large number of men and women to be interested in the reports published by school and health boards, for, with few exceptions, little effort is made to write these reports so that they will interest the parent. Fortunately, a small number of persons wishing to be intelligent can compel public officials to ascertain the necessary facts and to give them to the public. So backward is the reporting of public businessthat at the present time there is probably no service that a citizen can render his community which would prove of greater importance than to secure proper publicity from health and school boards.
Generally speaking, these published reports fail to interest the citizen, not because officials wish to conceal, but because officials do not believe that the public is interested. A mayor of Philadelphia once furnished a notable exception. He called at the department of health and complained against publishing the number of cases of typhoid and smallpox lest stories in the newspapers "frighten the city and injure business." A sanitary inspector who was in the room asked if Philadelphia's business was more important than the health of Philadelphia's citizens. As a result of her "impertinence" the inspector was removed. That same year an epidemic of smallpox spread through all the rural districts and cities of Pennsylvania, because physicians thought it would be kinder to the patients not to make known to their neighbors the presence of so disagreeable a disease. Almost all health and school authorities, however, can be made to see the advantage of taking the public into their confidence, because public confidence means both public recognition and greater success in obtaining funds. With more funds comes the power to do more work.
Other details with regard to health reports will be found in the chapter on Vital Statistics. As to school reports, little thought has been given in the past to their educational possibilities. A book was recently published—School Reports and School Efficiency—by the Committee on the Physical Welfare of School Children, which tells the origins of school reports; contains samples of reports from one hundred cities; gives lists of questions frequently answered, occasionally answered, and never answered; and shows how to study a particular report so as to learn whether or not important questions are answered. The United States commissionerof education has organized among state and city superintendents special committees on uniform and adequate reporting. His aggressive leadership is welcomed by school men generally, and promises vast benefits.
Just because the physical welfare of the school child is an index to health needs, the school report can put into one statement for a city or a state the story told by the index. The accompanying card tells facts that the individual teacher and individual parent want to know about a child, what a superintendent wants to know about all children, and what a community wants to know about all children. A modification of this card will soon be adopted in New York City. It is both a card index and a card biography of the individual boy or girl. It is expected to follow the child from class to class, each teacher telling the story of his physical welfare and his progress. When the boy goes to a new school or new grade, his new teacher can see at a glance not only what subjects have given him trouble, but what diseases or physical defects have kept him out of school or otherwise retarded his progress. With this card it is easy to take a hundred children of the same age and the same grade, to put down in one column those who have eye defects, and in another those who have no eye defects, for every school, every district, and for the schools as a whole. Schools that use these record cards are enabled, by thus classifying the total, to learn where the defects of children are, how serious the problem is, how many days children lose from school because of preventable defects, and in what section of the city the defects are most prevalent.
The mere reporting of facts will stimulate teachers, principals, and parents to give attention. For example, assume a table:
Field of Inspection
Total number of public schools7Public schools under inspection3Public schools not under inspection4
The reader wonders why four schools are neglected and which particular schools they are. Let the next table read:
Examination
Total registration in all schools1500Number of children examined500Number of children not examined1000
Parents begin to wonder whether or not their children were examined, and why the taxes spent for school examination of all children go to one third of the children. The next table arrests attention:
Treatment
Number needing treatment200Number known to have been treated50Number not known to have been treated150
We ask, at once, if examination is worth while, and if treatment really corrects the defects, saves the pupil's time and teacher's time, discovers many defects; and we want to find out whether the one hundred and fifty reported not treated have since been attended to.
Pupil's Record
Department Of Health City of New York Report
Again, if three out of five of those examined need treatment, people will wonder whether among the thousand not examined there is the same proportion—three out of five, or six hundred—who have some trouble that needs attention. Having begun to wonder, they will ask questions, and will expect the board of health or the school physicians to see that the questions are answered. As has been proved in New York, taxpayers and the press will go farther and will demand that the annual budget provide for making general next year the benefits found to result last year from a test of health policies.
The story of the prevalence of contagious diseases in school children could be told by a table such as is now in use by New York's department of health:
Table XII
Prevalence of Contagious Diseases in School Children
(Case rate schools)
SchoolGeneral Communicable Diseases1Communicable Diseases of Eye and Skin2NumberNumber per 1000 Registered in Schools InspectedNumber found by Inspectors and NursesNumber per 1000 Registered in Schools InspectedFound by InspectorsReported by Attending PhysicianTotalIn SchoolAmong AbsenteeABC1Smallpox, diphtheria, scarlet fever, measles, chicken pox, mumps, and whooping cough; excluded when found.2Trachoma and other contagious eye diseases, ringworm, impetigo, scabies, favus, and pediculosis; excluded only for persistent nontreatment.
Another table shows the following facts for each disease:
Table XIII
Contagious Diseases Found in Schools by Inspectors and Nurses
(Number and disposition of cases)
General Communicable DiseasesDiphtheriaScarlet feverMeaslesSmallpoxChicken poxWhooping coughMumpsTotalCases found in schoolCases excluded from schoolCases treated in schoolCases instructed in school or evidence of treatment furnishedNumber of treatmentsNumber of instructions
Communicable Diseases of Eye and SkinEyeSkinTrachomaOtherRingwormImpetigoScabiesFavusPediculosisMisc.TotalCases found in schoolCases excluded from schoolCases treated in schoolCases instructed in school or evidence of treatment furnishedNumber of treatmentsNumber of instructions
The story of noncontagious physical defects found and treated is set forth in the following table:
Table XIV
Medical Examination of School Children: Noncontagious Physical Defects Found and Treated, 1906
DefectsSchool ASchool BSchool CFoundReported TreatedFoundReported TreatedFoundReported TreatedNo.% of Total Defects FoundNo.% of Total Defects FoundNo.% of Total Defects FoundNo.% of Total Defects FoundNo.% of Total Defects FoundNo.% of Total Defects FoundAdenoidsNasal breathingHyper-trophied tonsilsDefective palateDefective hearingDefective visionDefective teethBad nutritionDiseased anterior cervical glandsDiseased posterior cervical glandsHeart diseaseChoreaPulmonary diseaseSkin diseaseDeformity of spineDeformity of chestDeformity of extremitiesDefective mentalityTotal
The effect of a report telling what schools have enough seats, proper ventilation, adequate medical inspection, safe drinking water, ample play space, and what schools are without these necessities is to cause the reader to rank theparticular school that he happens to know; i.e. he says, "School A is better equipped than School B; or, School C is neglected." County and state superintendents in many states have acquired the habit of ranking schools according to the number of children who pass in arithmetic, algebra, etc. It would greatly further the cause of public health and, at the same time, advance the interest of education if state superintendents would rank individual schools, and if county superintendents would rank individual schools,according to the number of children found to have physical defects, the number afflicted with contagious diseases, and the number properly treated.
It is difficult to compare one school with another, because it is necessary to make subtractions and divisions and to reduce to percentages. It would not be so serious for a school of a thousand pupils as for a school of two hundred, to report 100 for adenoids. To make it possible to compare school with school without judging either unfairly, the state superintendent of schools for Connecticut has made tables in which cities are ranked according to the number of pupils, average attendance, per capita cost, etc. As to each of these headings, cities are grouped in a manner corresponding to the line up of a battalion, "according to height." A general table is then shown, which gives the ranking of each city with respect to each important item. Applied to schools, this would work out as follows:
Table XV
Table of Ranking-Schools Arranged Alphabetically
SchoolRank inRegisterDefects FoundChildren Needing TreatmentChildren TreatedChildren not TreatedA101111126B2022222412C3033303618
Such a table fails to convey its significance unless the reader is reminded that rank 18 in children not treated is as good a record for a school that ranks 30 in register as is rank 6 for a school that ranks 10 in register.
The Connecticut report makes a serious mistake in failing to arrange schools according to population. If this were done, schools of a size would be side by side and comparison would be fair. When, as in the above table, schools are arranged alphabetically, a school with four thousand pupils may follow or precede a school with four hundred pupils, and comparison will be unfair and futile.
Where, on the other hand, schools are arranged in order of register, a table will show whether schools confronted with practically the same problems, the same number of defects, the same number of children needing treatment, are equally successful, or perhaps equally inactive, in correcting these defects. The following table brings out clearly marked unequal achievement in the face of relatively equal need.
Table XVI
Table of Ranking-Schools Arranged according to Register, not Alphabetically
SchoolRank inRegisterDefects FoundChildren Needing TreatmentChildren TreatedChildren not TreatedA99999X101010146H111111173
If the number of schools in a state is so large that it is unlikely that people will read the table of ranking because of the difficulty of finding their own school, an alphabetical table might be given that would show where to look in the general ranking table for the school or schools in which the reader is interested.
Experience will demonstrate to public school superintendents the strategic advantage of putting together all the things they need and of telling the community over and over again just what needs there are, what penalties are paid for want of them, and what benefits would result from obtaining them. If health needs of school children were placed side by side with mental results, the relation would come out so clearly that parents, school boards, and taxpayers would realize how inextricably they are bound together and would see that health needs are satisfied. To this end superintendents should require teachers to keep daily reports of school conditions.
Table XVII
Weekly Class-Room Schedule
TemperatureCleaningExercise10.3012.002.00DryWetDisinfectingIn RoomOut of RoomMondayTuesdayWednesdayThursdayFriday
The teacher's daily report of the temperature of a schoolroom, taken three times a day, tells the parent exactly what is the efficiency of the ventilating and heating apparatus in the particular school in which he is interested; whereas the report of the department of buildings gives only the number of schools which have an approved system of ventilation and steam heat. School authorities may or may not know that this system of ventilation is out of order, that the thermometer in the indoor playground of School A stood at forty degrees for many days in winter. But they must know it when the principal of School A sends in a daily record; the school board, the parents, or the presswill then see that the condition is remedied. If the condition is due to lack of funds, funds will never be forthcoming so long as the condition is concealed.
Similar results will follow publicity of overcrowding, too little play space, dry cleaning of school buildings, etc. The intent of such reporting is not to "keep tabs" on the school-teacher, the school child, the janitor, the principal, superintendent, or board, but to insure favorable conditions and to correct bad conditions. This is done best by giving everybody the facts. The objective test of the efficiency of a method throws emphasis on the method, not on the motive of those operating it. The blackboard method of publishing facts concentrates attention upon the importance of those facts and enlists aid in the attainment of the end sought.