MANUAL OF INSTRUCTIONS for School Authorities and School Physicians. Class. *•"* % Book X(o ft t> 191 i fr MANUAL OF INSTRUCTIONS FOR School Authorities and School Physicians Issued jointly by the Indiana State Board of Education and the Indiana State Board of Health, as provided in Section 5 of the Medical School Inspec- tion Law, approved March 6, 1911 CHAS. A. GREATHOUSE, President State Board of Education [SEAL] J. N. HURTY, S«cretary State Board of Health [SEAL] ^ 4 -33 2. MANUAL OF INSTRUCTIONS SCHOOL AUTHORITIES AND SCHOOL PHYSICIANS Issued jointly by the Indiana State Board of Education and the Indiana State Board of Health, as provided in Section 5 of the Medical School Inspection Law, approved March 6, 1911 CHAS. A. GREATHOUSE, J. N. HURTY, President State Board of Education Secretary State Board of Health [seal] [seal] INDIANAPOLIS : WM. B. BURFORD, CONTRACTOR FOR STATE PRINTING AND BINDING 1911 i\ \ % ^ b TABLE OF CONTENTS Page Medical School Inspection Law IS Sanitary Schoolhouse Law 6 Rules for Quarantine and Exclusion from School 11 Directions for Disinfection , 1.5 Rules for the Medical Inspector , . . 21 Rules for the Teacher 22 Blank Forms ..... .25-31 Teaching of Hygiene • • 31 Comments on Sanitary Schoolhouse Law 32 6 \%n (2) INTRODUCTION, The most valuable asset that any child can possess is good health. The health of the child very largely determines the suc- cess of the adult, and what we should be most concerned about in education is the laying up of vital assets for. use in the active battle of life. One of the most commonplace of our proverbs tells us that : ' * Prevention is better than cure, ' ' yet it has here- tofore been with the greatest difficulty that the public could be convinced that the prevention of defects in school children is better than their cure. The State of Indiana has taken a forward step in providing by law for the erection of sanitary schoolhouses and for medical in- spection of school children, and it will not be long until every school which makes any claim to progressiveness is provided with intelligent supervision of the health conditions of its pupils. This manual is intended to cover in a brief way all the essen- tials necessary in the beginning of medical school inspection. No comprehensive plan can be outlined that will meet the needs of every school community. Medical inspection must be established in the different school communities of the State and worked out along lines that will meet the local conditions. So far as pos- sible, it is the aim of this manual to have the fundamental prin- ciples of sehool inspection carried out uniformly throughout the State. Hence the rules herein set forth have been made as simple and plain as possible. The institution of medical inspection by the Act of 1911 must be regarded not only as an attempt to safe- guard the lives and health of the pupils in our public schools, but is also a foreshadowing of better things to come." The legis- lature has done its part and has prepared the way. It now rests with school and health officials to realize their responsibilies. to arouse public sentiment from its present state of apathy and by fulfilling the spirit as well as the letter of the law to develop the scheme of medical inspection into an efficient system of preven- tion. Administrative expenditure of this kind is the soundest econ- omy. No higher work can be conceived than that of conserving (3) and safeguarding the health and lives of the children in the public schools of Indiana. As has been well said by David Starr Jordan : "There is nothing in all the world so important as little children, nothing so interesting. If ever you wish to go in for philanthropy, if ever you wish to be of any real use in. the world, do something for children. We can dress the sore, bandage the wounded, imprison the criminal, heal the sick and bury the dead, but there is always the chance that we can save the child. If the great army of philanthropists ever exterminate sin and pestilence, ever work out our race's salvation, it will be because a little child has led them." THE SCHOOLS AND HEALTH. That health is an asset is now realized by every one. It is a crime for anyone to suffer from a curable or preventable disease. Since the strength of a State depends upon the strength and char- acter of its citizens, it becomes the duty of the State for its own protection to safeguard the health of its own people. It would seem that in no other place can this duty of the State be more fully met than in protecting and safeguarding the health of its future citizens in the public schools. It would seem also that a compulsory education law ought to be preceded by a law providing for the health and care of young people. Since such a law was not enacted before the compulsory education law, the legislature of 1911 very wisely enacted the Sanitary Schoolhouse Law, which follows. This law marks an advanced step, in the educational system of Indiana and will do much to conserve the health and normal physical development of the pupils in the public schools, as well as to increase the efficiency of school work. THE SANITARY SCHOOLHOUSE LAW. AN ACT entitled an act to protect the health and lives of school children, and increase their efficiency, by providing healthful schoolhouses, and requiring the teaching of hygiene. (S. 28. Approved March 1, 1911.) Schools — Sanitary Buildings. Section 1. Be it enacted by the General Assembly of the State of Indiana, That after the going into effect of this act, all school- houses which shall be constructed or remodeled, shall be con- structed in accordance and conform to the following sanitary principles, to-wit : (a) Sites. All sites shall be dry, and such drainage as may be necessary to secure and maintain dry grounds and dry build- ings, shall be selected and supplied. Said site and said buildings shall not be nearer than 500 feet to steam railroads, livery stables, horse, mule or cattle barn used for breeding purposes, or any un- healthful conditions. Good dry walks shall lead from the street or road to every schoolhouse and to all outhouses, and suitable playgrounds shall be provided. (b) Buildings. School buildings, if of brick, shall have a stone foundation, or the foundation may be of brick, or concrete: Provided, A layer of slate, stone or other impervious material be interposed above the ground line, or the foundation may be of vitrified brick and the layer of impervious material will not be required. Every two-story schoolhouse shall have a dry, well- lighted basement under the entire building, said basement to have a cement or concrete floor and ceiling to be not less than ten feet above the floor level. The ground floor of all schoolhouses shall be raised at least three feet above the ground level and have, when possible, dry, well-lighted basement under the entire building, and shall have a solid foundation of brick, tile, stone or concrete, and the area between the ground and the floor shall be thoroughly ven- tilated. Each pupil shall be provided with not less than 225 cubic feet of space, and the interior walls and ceiling shall be either painted or tinted some neutral color, as gray, slate, buff or green. (c) Lighting and Seating. All schoolrooms w.here pupils are seated for study, shall be lighted from one side only and the glass (6). area shall be not less than one-sixth of the floor area and the win- dows shall extend from not less than four feet from the floor to at least one foot from the ceiling, all windows to be provided with roller or adjustable shades of neutral color, as blue, gray, slate, buff or green. Desks and desk seats shall preferably be adjust- able, and at least twenty per cent, of all desks and desk seats in each room shall be adjustable, and shall be so placed that the light shall fall over the left shoulders of the pupils. For left-handed pupils desks and seats may be placed so as to permit the light to fall over the right shoulder. (d) Blackboards and Cloakrooms. Blackboards shall be pref- erably of slate, but of whatever material, the color shall be a dead black. Cloakrooms, well lighted, warmed and ventilated, or sani- tary lockers, shall be provided for each study schoolroom. (e) Water Supply and Drinking Arrangements. All school- houses shall be supplied with pure drinking water and the water supply shall be from driven wells or other source approved by the health authorities. Only smooth, stout glass or enameled metal drinking cups shall be used; water buckets and tin drinking cups shall be unlawful and are forbidden ; and whenever it is prac- ticable, flowing sanitary drinking fountains which do not require drinking cups, shall be provided. All schoolhouse wells and pumps shall be supplied with troughs or drains to take away waste water, and under no conditions shall pools or sodden places or small or large mudholes be allowed to exist near a well. When water is not supplied at pumps or from water faucets or sanitary drinking fountains, then covered tanks or coolers supplied with spring or self-closing faucets shall be provided. (f) Heating and Ventilation. Ventilating heating stoves, fur- naces, and heaters of all kinds, shall be capable of maintaining a temperature of 70 degrees Fahrenheit in zero weather and of main- taining a relative humidity of at least 40 per cent., and said heaters of all kinds shall take air from outside the building and after heating, introduce it into the schoolroom at a point not less than five nor more than seven feet from the floor, and at a minimum rate of thirty (30) cubic feet per minute for each pupil, provided, that when direct-indirect steam heating is adopted, this provision as to height of entrance of hot air shall not apply. Halls, office rooms, laboratories and manual training rooms may have direct steam radiators, but direct steam heating is forbidden for study schoolrooms, and direct-indirect steam heating is permitted. All 8 schoolrooms shall be provided with ventilating ducts of ample size to withdraw the air at least four times every hour, and said ducts and their openings shall be on the same side of the room with the hot air ducts. (g) Water-closets and Outhouses. Water-closets or dry closets when provided, shall be efficient and sanitary in every particular and furnished with stalls for each hopper or place; and when said water or dry closets are not provided, then sanitary outhouses, well separated for the sexes, shall be provided. Good dry walks shall lead to all outhouses and screens or shields be built in front of them. Outhouses for males shall have urinals arranged with stalls and with conduits of galvanized iron, vitrified drain pipe, or other impervious material, draining into a sewer, vault or other suitable place, approved by the health authorities. Any school trustee or trustees who shall build or construct any schoolhouse or cause to be built or constructed any schoolhouse which does not include each and every sanitary provision commanded in this act, shall, upon conviction, be fined in any sum not less than one hundred nor more than five hundred dollars ; and any money claim for the material entering into, or any money claim for the construction of any schoolhouse which does not in every way and all respects comply with the requirements of this act shall be null and void. Temperature— Uncleanliness — Teachers — Penalties. Sec. 2. Whenever, from any cause, the temperature of a school- room falls to 60 degrees Fahrenheit or below, without the imme- diate prospect of the proper temperature, namely, not less than 70 degrees Fahrenheit, being attained, the teacher shall dismiss the school until the fault is corrected ; and it shall also be the duty of all teachers to immediately send home any pupil who is perceptibly ill in any way, or who is unclean and emits offensive bodily odors or who is infested with lice or other vermin ; and the truant officer shall arrest and prosecute parent or guardians who do not rid their children of vermin and bodily uncleanliness, when notified to do so. Refusal of parents or guardians to free their children or wards of vermin or to bathe and cleanse them, making them fit to go to school, shall be punished by a fine of not less than five dollars and imprisonment for ten days or both. And if the refusal or neglect of parents or guardians to bathe and cleanse their children or wards makes it necessary, then the truant officer, upon order of the school authorities, shall have it done, the cost to be paid by the school authorities from the school funds. Whenever diphtheria, scarlet fever or other contagious and infectious diseases break out in any school it shall be the duty of the township trustee, school board, school trustee or the school authority or authorities having control, to have medical inspection made of the pupils, and all found in any degree ill shall be sent home and there retained until the local health officer gives a certificate of health, then such child may be again admitted to school. It shall be unlawful for school authorities to employ teachers or janitors who are not able-bodied or who are addicted to drugs or intemperate, or who have tuberculosis or syphilis. All schoolhouses shall be specially cleaned and disin- fected each year before they are used for school purposes. The cleaning shall consist in first sweeping, then scrubbing the floors, washing the windows and all woodwork, including the wooden parts of seats and desks, and the disinfecting shall be done in ac- cordance with the rules of the State board of health. Township trustees, school boards and boards of school commissioners who neglect or refuse to obey the provisions of this section shall be fined in any sum of not less than ten nor more than one hundred dol- lars, and each said refusal or neglect shall constitute a separate offense. Hygiene and Sanitary Science — Printed Data. Sec. 3. There shall be taught in each year in the fifth grade of every public school in Indiana, the primary principles of hygiene and sanitary science, and especially shall instruction be imparted concerning the principal modes by which each of the dangerous, communicable diseases are spread, and the best sanitary methods for the restriction and prevention of each such disease. Hygiene may also be taught in other grades at the will of school authorities. The State health commissioner and the State superintendent of public instruction shall jointly write, compile or originate printed data in leaflet form, setting forth as plainly as possible, the pri- mary principles of hygiene and sanitary science, and information concerning the prevention of diseases, and supply the same to all county superintendents, and said superintendents shall supply all the schools in their respective counties and see to it that teachers do not fail to comply with this section ; Provided, That for all cities and towns having school superintendents, the said leaflets and pamphlets shall be sent direct to such superintendents, who shall see to it that teachers comply with this section. The State printing 10 board shall publish from its funds all health leaflets or pamphlets as are herein provided for, and shall also pay the cost of distribu- tion of the same to the county, city or town superintendents, from the State printing funds. School Officers — Powers. Sec. 4. For the purpose of enforcing this act and making it practical, township trustees, boards of school trustees and boards of school commissioners shall have the power, and it is herewith made lawful for said trustees and said boards to make a levy not to ex- ceed five cents (5 cents) on each one hundred dollars ($100.00), the sum thus raised to be added to the special school fund, but to be used only for building and furnishing of schoolhouses. This levy shall not be made unless plainly necessary. Penalty as to Officers. Sec. 5. Any township trustee or the members of any board of school trustees or any teacher or any person who violates any pro- vision of this^act, except as herewith or otherwise provided, shall upon conviction, be fined not less than $50.00. Repeal. Sec. 6. All laws in conflict with this act are repealed. INDIANA STATE BOARD OF HEALTH RULES GOVERN- ING QUARANTINE AND EXCLUSION FROM SCHOOLS. Rule 1. The infectious and contagious diseases which shall be immediately reported to the health officer having jurisdiction and which shall be quarantined are hereby declared to be : Yellow fever, smallpox, cholera, diphtheria, membranous croup, scarlatina (scar- let fever), measles, typhus fever, bubonic plague, leprosy, cerebro- spinal meningitis, poliomyelitis, pulmonary consumption, typhoid fever, chickenpox and whooping cough. Provided, Pulmonary consumption and typhoid fever shall not be quarantined, but are to be reported for record only. And chickenpox, whooping cough and measles shall be carded to warn the public, absolute quarantine not being required. When quarantine has been estab- lished as provided by law the quarantine card or flag shall remain in place until after the patient has been removed from such house or has recovered and is no longer capable of communicating the disease, and the house and contents thereof have been properly dis- infected by order of the health officer having jurisdiction. Rule 2. Every physician attending a person affected with any quarantinable disease shall use every precaution to prevent com- municating the disease to others. To this end the board recom- mends that a cap and gown, linen duster, rubber coat or other sufficient cover for the clothing be worn. Before leaving the prem- ises the hands, and face should be cleansed with soap and water and a disinfecting solution. The coat, cap, antiseptic soap and bottle of disinfectant should be carried in a special receptacle which should contain a piece of cotton constantly wet with formal- dehyde. Health officers and attending physicians should give full and explicit instructions to parents, nurses and attendants con- cerning every precaution to be taken against the spread of in- fectious disease. Rule 3. Any house or building and its contents in which a case of quarantinable disease, and including tuberculosis and typhoid fever, has occurred shall be disinfected under the supervision of the health officer having jurisdiction, or his deputy, in accordance with the rules of the State board of health. 12 Rule 4. The minimum period of isolation, quarantine and ex- clusion from school in contagious diseases shall be as follows: SMALLPOX. For the patient, quarantine for not less than twenty- one (21) days after the beginning of the disease and until all crusts and scales have fallen off or been removed, and the disinfection of patient, clothing and premises. For exposed persons, quarantine for fourteen (14) days from date of last exposure unless successfully vaccinated or pro- tected by a previous attack of the disease, and person and clothing have been disinfected : Provided. That persons who have not been previously vaccinated and who shall submit to vaccination may be released from quarantine after disinfection of person and clothing when It has been shown that such vaccination is successful. Exclusion from school for seven (7) days following the removal of quarantine. SCARLET FEVER. For the patient and children in the family witli the patient, quarantine for not less than twenty-one (21) days after the be- ginning of the disease. Exclusion of the patient and children associated with the patient, from school for ten days after removal of quarantine. Other children of the family may, at the discretion of the health officer hav- ing jurisdiction, be disinfected and removed to another house and shall there be isolated and excluded from school for a period of ten days and then re- leased, provided they remain free from the disease. For adults living in the family with or exposed to the patient : — While the house remains quar- antined, unless said adults submit to thorough disinfection of the body and clothing and do not come in contact with the patient. DIPHTHERIA. For the patient, quarantine untilthe secretions from the nose and throat are free from the diphtheria infection as shown by bacteriological examination of such secretions. For children associated with or in the family with the patient, quarantine until death or recovery of the patient and disinfection of person, clothing and premises : Provided, That other children of the family who shall receive an immunizing dose of antitoxin of not less than 1,000 units, may be released from quarantine at the discretion of the health officer having jurisdiction, after disinfection of person and clothing. The patient shall be excluded from school until a med- ical certificate that the nose and throat are free from infection, based upon bacteriological examination, is furnished. Children associated with or in the family with the patient shall be excluded from school for seven (7) days after release from quarantine unless a medical certificate of having received an immunizing dose of not less than 1,000 units of antitoxin is furnished. Adult members of the family may be released from quaran- tine on the condition that they be disinfected in person and apparel and remain away during the quarantine period. EPIDEMIC CEREBRO=SPINAL MENINGITIS. For the patient, isolation from the rest of the family and quarantine for not less than fourteen (14) days after the first appearance of the disease until death or recovery of the patient and disinfection of the premises. Persons living in a house where the disease is present shall not mingle with the general public until the disease has terminated and the premises have been thor- oughly disinfected. And children from said house shall be excluded from school during the quarantine period. 13 MEASLES. For the patient, isolation and quarantine for not less than fourteen (14) days and until peeling or desquamation has ceased. Pa- tient shall not be permitted to attend school for five (5) days after quar- antine has been removed. For other members of the family, quarantine is not required, but children in the household must not attend school or other public gatherings or mingle with other children unless satisfactory proof shall be furnished to the health officer having jurisdiction of their having had the disease, in which event the said health officer may, at his discretion, permit the said children to attend school and other public gatherings. WHOOPING=COUGH. For tne patient, isolation and quarantine for not less than five (5) weeks from the beginning of the disease and until the "whoop" has entirely ceased. For other members of the family quar- antine not required, but Children of the same household must not attend school or other public gatherings or mingle with other children, unless satisfactory proof shall be furnished of having had the disease, in which event the health officer having jurisdiction, at his discretion, may permit at- tendance at school. CHICKENPOX. For the patient, quarantine for not less than four- teen (14) days from the beginning of the disease and until all scales and crusts have disappeared. Children living in houses where the disease ex- ists are to be excluded from school two (2) weeks unless satisfactory proof of having had the disease is furnisned. EPIDEMIC POLIOMYELITIS. For the patient, isolation and quar- antine for not less than twenty-eight (28) days from the beginning of the disease. For other members of the family, at the discretion of the health officer having jurisdiction: Provided, That the wage earners may be al-" lowed to attend to their work by observing the precautions recommended by the health officer. Other children in the family shall not be permitted to attend school or public gatherings or to mingle with other children for a period of fourteen (14) days after the beginning of quarantine. Rule 5. When it is known that a person has attended school while suffering from any of the following named diseases : Measles, scarlet fever (scarlatina), diphtheria (membranous croup), small pox, epidemic cerebro-spinal meningitis, epidemic polomyelitis cholera, or bubonic plague, the local health officer shall cause the schoolroom occupied by such person to be thoroughly disinfected according to the rules of the State board of health, before being used again for school purposes. Rule 6. When a case of contagious disease is reported it shall be the duty of the health officer having jurisdiction to ascertain the schools attended by any children from the infected premises and to serve notice upon those in charge of such schools, requiring that all persons from such infected premises be excluded from the school until a medical certificate or a written permit from the health officer is presented i7 w Rule 7. When a person affected with any of the quarantinable diseases has recovered and is no longer able to communicate the disease to others, or has died, the attending physician shall notify the health officer, and as soon thereafter as the health officer deems it advisable the house in which such person has been ill and the contents thereof shall be thoroughly disinfected by the health of- ficer or his deputy. Rule 8. The sale or use of milk or dairy or food products from the premises where one of the quarantinable diseases exists or where typhoid fever is present is strictly forbidden unless the milk, dairy or food products are handled, cans" and pails washed and stock cared for by persons entirely segregated from the affected person and family, and then only upon permission of the local health officer. Rule 9. No milk bottles shall be taken from premises on which a quarantinable disease exists until after the quarantine has been raised and said bottles have been thoroughly cleansed and disin- fected by the proper health officer. Milk tickets and bread tickets shall not be taken from such premises, but shall be destroyed. No mail matter shall be taken away from such premises while the premises are under quarantine. Cats and dogs and other domestic animals belonging to premises under quarantine shall be kept out of the house and from contact with the patient. Should these pre- cautions not be observed strictly, it shall be the duty of the health officer to cause such domestic animals to be destroyed. Rule 10. The body of a person who has died of any of the quarantinable diseases mentioned in Rule 1 shall not remain un- buried for a longer period of time than twenty-four (24) hours after death, unless embalmed and thoroughly prepared by a licensed embalmer. The undertaker or persons acting as such shall be re- sponsible for any violations of the provisions of this rule. Rule 11. All services held in connection with the funeral of a body of a person who has died of any of the diseases mentioned in Rule 1 shall be private. The attendance thereat shall include only the immediate adult relatives of the deceased, the necessary number of adult pallbearers, the minister and undertaker. Such services shall be held only in the home and any advertisement of such funeral shall state the cause of death. DIRECTIONS FOR SCHOOLHOUSE DISINFECTION. The Sanitary Schoolhouse Law of 1911, under section 2, pro- vides that "All schoolhouses shall be especially cleaned and disin- fected each year before they are opened for school purposes. The cleaning shall consist in first sweeping, then scrubbing the floors, washing the windows and all woodwork, including the wooden parts of seats and desks, and the disinfecting shall be done in accordance with the rules of the State board of health. ' ' The rules of the State board of health provide that disinfection of schoolhouses shall be done as follows: 1. Carefully close all windows and doors, except one door for exit. Paste paper over stovepipe holes, and apply wetted paper or, better, paste paper strips over all windows, transom or door cracks. In a word, seal the room tightly with paper strips from the inside. 2. Open closet doors, drawers, trunks, boxes, etc. Suspend clothing upon lines stretched across the room, or spread out on chairs or clothes horse. All books must be opened and the leaves spread. In short, the room and its contents must be so disposed as to secure free access of gas to all parts and all objects. 3. Make the air in the room damp ; this is absolutely neces- sary for disinfecting by formaldehyde. Dampness may be pro- duced (a) by boiling water on a gas, gasoline or oil stove; (b) by pouring boiling hot water from a teakettle into a tub; (c) by pour- ing hot water onto bricks or stone, or by dropping hot bricks or stones into vessels containing water. Under no circumstances is efficient disinfection possible without in some way making the air of the room quite damp. 4. Measure the room and multiply the length, breadth and height together. This will give the contents in cubic feet. Divide by 1,000, and this gives the number of thousand cubic feet in the room. This is called the unit space. 5. Measure the room, and for each 1,000 cubic feet (unit space) use two pints of formaldehyde and three and one-half ounces of commercial permanganate of potassium. Procedure : Place a large washbowl, crock, tin dishpan or galvanized iron pan or tub in the center of the room. Put in the required amount of permanganate of potassium and lastly, pour in the required amount of formald<> 16 hyde. Permanganate must be put in first. Retire immediately after pouring in the formaldehyde, for the formaldehyde gas is promptly released and is injurious if breathed in any quantity. Keep the room closed for at least three hours, then open, air thor- oughly, and clean in the usual way. Solidified formaldehyde may be used for gaseous room disin- fection, using not less than one ounce of solidified formaldhyde for each 1,000 cubic feet, not neglecting moisture. HEALTH SUPERVISION IN PUBLIC SCHOOLS. The necessity for careful supervision of the health and develop- ment of school children is no longer open to argument. The people themselves are demanding such supervision as the most vital func- tion of the public school system, so that no school can any longer claim a place in modern educational progress which ignores or neglects the health conditions of its pupils. In the light of present knowledge concerning the health of school children, it may be said that a community which neglects a systematic health care of its school pupils is guilty of criminal negligence. If all parents were sufficiently wise in health matters it would probably be unneces- sary for schools to make any special study of the physical condition of the children entrusted to their care. But it is a fact, and not a theory, that not all nor even most parents are wise in matters pertaining to the health condition of their children. It becomes, therefore, the plain duty of the school department to furnish not only a healthy school environment, but also a careful guardianship of the personal health of its pupils. Medical supervision includes far more than inspection. It means a health study in a broad sense of the pupils in the schools, with an attempt to adjust them to their physical environment. It means a study of the condition of sight, hearing, an examination for evidence of nasal obstruction, diseased tonsils, seriously de- fective teeth, disorders of nutrition and development, unbalanced nervous organism, for signs of early heart or lung disease, for en- larged glands, skin diseases, and symptoms of children's common contagious diseases. It means the careful physical study of school children, for it has been shown clearly that there is an intimate relation between the child's -physical condition and his mental progress and future success. Facts obtained from actual observation in many different schools of Indiana show that of all the pupils in the public schools below and including the eighth grade, 60 per cent, suffer from some physical defect that to a greater or less degree impairs their mental efficiency ; that fully 25 per cent, of all grade pupils have diseased tonsils ; that 18 to 20 per cent, have defective vision ; that 15 per cent, have adenoids; that 8 to 10 per eent. have defective hearing. (17) IS and that fully 35 per cent, have defective teeth to such an extent as to impair nutrition, thus seriously decreasing their mental ef- ficiency. In the face of these facts no argument is needed in favor of medical school inspection. All who are interested in health inspection realize that it will cost. All good and desirable things do cost. We have long since recognized the need of properly inspecting our domestic animals, and we gladly pay the cost for this work. The children of a State are truly its most valuable asset. We, therefore, should not only be willing but anxious to pay whatever is necessary for their care. Medical inspection of school children looks to the future as well as to the present. By relieving and removing present defects it pre- pares for a stronger nnd sturdier body of citizens in the near future. In order to bring about such a result the citizens of the present should willinsrlv make the needed investment MEDICAL SCHOOL INSPECTION LAW. AN ACT entitled an act to protect and conserve the health and lives of school children and promote their efficiency by providing for their medi- cal inspection and subsequent necessary treatment. (H. 27. Approved March 6, 1911.) Schools — Medical Inspection of Children. Section 1. Be it enacted by the General Assembly of the State of Indiana, That all school trustees and township trustees are here- with permitted and recommended to institute medical inspection of school children at any time ; the said trustees may require teach - erg to annually test the sight and hearing of all school children under their charge, the said tests and uses thereof to be made according to the rules hereinafter authorized. Medical Inspection Defined. Sec. 2. The term, medical inspection, as used in this act, shall be held to mean the testing of the sight and hearing of school children and the inspection of said children by school physicians for disease, disabilities, decayed teeth or other defects, which may reduce efficiency or (ond to prevent their receiving the full benefits of school work. School Physician — Appointment — Compensation. Sec. 3. Beginning with the school year 1911, school trustees and township trustees may appoint at least one school physician for each school corporation : Provided, Where practicable, two or more school corporations may unite and employ one such physician, whose duties shall bo such as are prescribed in this act and the authorized rule*, bul no physician shall have more than 2,000 school children under his charge. Said school physicians shall be graduates of a medical college, recognized by the State board of registration and examination, shall hold a license to practice medi- cine in Indiana, and shall be informed and skilled in medical inspec- tion of children, informed in the health laws and the health rules of the State board of health, shall be temperate, able-bodied, cleanly in person, not addicted to drugs, and of good moral character, and no others shall be appointed. School physicians may be discharged by the appointing power at any time. School physicians shall 8 p r vp one year and until their successors are appointed, and shall -• - 20 receive such compensation as the appointing trustee or trustees may determine. Physician's Duties. Sec. 4. School physicians shall make prompt examination and diagnosis of all children referred to them and such further exam- ination of teachers, janitors and school buildings as in their opinion the protection of the health of the pupils and teachers may require. Whenever a school child is found to be ill or suffering from any physical defect, the school physician shall promptly send it home, with a note to parents or guardians, briefly setting forth the dis- covered facts, and advising that the family physician be consulted. If the parents or guardians are so poor as to be unable to give the relief that is necessary, then school trustees and township trustees, as the case may be, shall provide the necessary relief : Provided, That in cities where public dispensaries exist the relief shall be given by said dispensaries. School physicians shall keep accurate card-index records of all examinations, and said records, that they may be uniform throughout the State, shall be according to the form prescribed by the rules authorized in this act, and the method and manner of reports to be made shall be according to said rules : Provided, however, That if the parents or guardian of any school child shall at the beginning of the school year furnish the written certificate of any reputable physician that the child has been ex- amined and parents notified of the results of such examination in such cases the services of the medical inspector herein provided shall be dispensed with, and such certificate shall be furnished by such parent or guardian from time to time, as required by the trustee or board of trustees having charge of such schools. Rules for Enforcement. Sec. 5. The State board of education and the State board of health shall jointly pass rules for the detail enforcement of the purposes of this act, which rules shall bear the printed seals of said boards ; the said rules to be printed and promulgated by the State printing board; promulgation to consist in supplying a rea- sonable number of copies to each county superintendent, from whom all who are interested may procure a copy. Penalty. Sec. 6. All violations of this act, except as otherwise provided, shall b? pnniahArJ by » finp of nnj loos than ten or more thin fifty RULES FOR MEDICAL SCHOOL INSPECTION. THE SCHOOL PHYSICIAN. Rule 1. It shall be the duty of the school physician to ex- amine all school children as soon as practicable after their first ad- mission to school. This examination shall take note of said children as to cleanliness, obvious physical defects, as physical deformities, condition of nose and throat, and teeth, ear discharges, squints, gen- eral fitness for school life and previous medical history. Measure- ment of height and weight shall be recorded. This first examination shall be conducted in the presence of the parents or family physi- cian, if so desired. (Provided, that any child presenting a certifi- cate of examination as provided in the medical inspecton law, shall be exempt from the school ph'yscian's examination.) A permanent record of all such examinations shall be kept on blanks, according to form prescribed by the State board of education and State board of health. Such records to be subject to inspection by the public only on an order from the school physician. Rule 2. It shall be the duty of the school physician to make an examination of all children referred to him by teachers. Such examination to consist of whatever may be necessary to determine whether or not the child should be excluded from school. Such examination shall be made in the presence of the parents if so de- sired. In all matters pertaining to exclusion from school the de- cision of the school physician shall be final. A. record shall be kept of all such examinations on forms shown in this manual, to be pro- vided by the school authorities, a copy of which shall be furnished the parents or guardian of said children. Rule 3. It shall be the duty of the school physician to make a general examination of all the children in the public schools at least once a year for any defect or disability tending to interfere with their school work, and a special examination of children (a) who show signs of being in ill health or of suffering from infec- tious or contagious diseases (b) who are returning to school after absence on account of illness or from unknown cause. Rule 4. It shall be the duty of the school physician to make such examinations of teachers, janitors and school buildings as in his opiDi^n l"-h*» jvrntpptinn of Hip health of thp pupils may rpqrnro 22 RULES FOR TEACHERS. The teachers in all the public and parochial schools of the State of Indiana shall test the sight and hearing of all school children under their charge, once in each school year, and at such other times as may be necessary. The sight test shall be made by the use of the Snellen's Test Type Chart and the hearing test shall be by the watch test or the whisper test, preferably the whisper test. An individual record shall be kept of said test and whenever a defect of vision or hearing is noted the case shall be referred to the school physician. Teachers and school officials shall rigorously exclude from school all children specified in any notice of exclusion issued either by the school physician or by the local health officer until such children shall present a certificate of admission from the school physician or the health officer. RULES FOR TESTING EYESIGHT. Rule 1. The annual test for eyesight and hearing shall be made as early in the school year as possible, preferably in Septem- ber. Individual pupils may be tested at any time that a test is considered necessary. Rule 2. All tests shall be made as nearly as possible under the same conditions and shall be supervised by the principal or superintendent, in order to see that the conditions of the test are uniform as far as possible for the different classes. Rule 3. Do not expose the test type chart except when in use, as familiarity with the chart leads children to learn the letters "by heart." Children should be examined singly. Rule 4. Test each eye separately. Have the pupil begin at the top of the test card and read down as far as ho can, first with one eye and then with the other. Hold a card over one eye while the other is being examined, but do not press on the covered eye, a« pressure may produce an incorrect examination. Rule 5. Place the test chart on the wall in a good light at about the level of the pupil's head and at a measured distance of 20 feet from the pupil. The chart should have a good side illumina- tion and not hang in range of a window, which will dazzle the eyes. Rule 6. Children wearing glasses shall be tested with the glasses properly adjusted, and if sight is found normal with the glasses it shall be recorded as normal 23 Rule 7. Record as defective only those whose vision is 10-20 or less in either eye. Rule 8. Where the child cannot name the individual letters, although able to read, the chart figures may be used. If the child does not know figures or letters, use the chart of inverted E's, asking the child to tell by the movement of the hand the side on which there is an opening on the E's, i. e., up, down, right or left. Rule 9. The lines on the chart are numbered to indicate the distance the respective letters should be read by the normal eye. The record is made by a fraction, of which the numerator repre- sents the distance of the chart from the child and the denominator the lowest line he can correctly read. Thus, if at 20 feet the pupil reads the line marked 20 feet, the vision is 20/20 or normal. If he only reads correctly the line above marked 30 feet, his vision is 20/30 or 2/3 normal. If at a distance of 20 feet the pupil can only read correctly the line marked 40 feet, the vision is 20/40 or 10/20, which must be recorded as defective. If a pupil cannot read the largest letters he must go slowly toward the chart until he can. The distance he is from the chart when he can read the largest letters will be the numerator and 200 the denominator. Rule 10. Report to the State board of health the total number of children examined and the number found defective in eyesight and hearing by test. METHOD OF TESTING HEARING. The person conducting the test should be possessed of normal hearing. The examination should be conducted in a room not less than 25 feet long and situated in as quiet a place as possible. The floor should be marked with parallel lines, one foot apart and num- bered. The child should sit in a revolving chair in the first space. Examination should be made with the whisper or spoken voice. The child should repeat what he hears and the distance at which words can be heard distinctly should be noted. The two ears should be tested separately. The test words may consist of num- bers from one to one hundred and short sentence. It is best that but one pupil at a time be allowed in the room, to avoid imitation. The standard to be adopted is as follows : In a still room the stand- ard whisper can be heard easily at 25 feet. The whisper of a low voice can be heard from 35 to 45 feet and of a loud voice 50 to RO feet 24 In the watch test the ticking of a watch is used instead of the voice. The watch test, however, cannot be depended upon for the reason that children when asked if they hear the ticking of a watch will answer, "Yes," when in fact they do not hear the watch. For this reason the whisper test should be used. BLANK FORMS. The following blank forms are recommended for use in connec- tion with the institution of school inspection, in order that the system of supervision and records may be uniform wherever med- ical inspection is established throughout the State. 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