DENVER MEDICAL TIMES VOLUME XXIV. CONSIDERATIONS REGARDING MEDICAL INSPECTION IN THE PUBLIC SCHOOLS.* By EDWARD JACKSON, M.D., We study disease that life and health may be preserved. Medicine began with men already stricken by wound or poison or infection, and the things looked to for their direct relief. It has advanced to warning them of impending danger, whether from pestilence or tainted food or brittle arteries. The line of continued advance is toward development of the greatest possibilities of life and health by knowledge applied to the whole scheme of living. Hygiene understood, taught, practiced, made dominant in the public schools is the next step in this progress. School hygiene must include attention to actual disease within the schools and provision for its treatment; the immediate suppression of epidemics; the recognition of all physical defects among the pupils, with steps to help secure their correction as far as possible; maintenance of the best sanitary conditions throughout the whole school environment of the child; the training by verbal instruction, exercises and habitual practice of general and individual hygiene; and the inspiring in every scholar the same reverence for health that we seek to instill with regard to patriotism or moral obligation. Without claiming that this work of fundamental and universal importance is to be done wholly by the medical profession, it is obvious that it must at many points be guided by and founded upon that mass of knowledge which has been and is being laboriously accumulated by the medical profession; and much of which is available from no other source. * Read before the American Academy of Medicine at Atlantic City, N. J., June 6, 1904, as part of a report on Hygiene in the Public Schools, and published here courtesy of the Bulletin of the Academy. Medical inspection or medical supervision of schools is the chief agency through which our knowledge of vital processes and disease is to be applied. We say medical supervision for mere inspection ending in itself would be a farce. There must be both seeing and doing. Inspection takes value and significance only as it becomes the first step toward modifying what it discovers. But for efficiency the circuit from seeing to doing must be shortened as much as possible. So far as may be the eyes to see, the knowledge to appreciate and the judgment and authority to act should be vested in the same person, and in the immediate future this person will generally be the medical inspector. Generally but not always. Even at the present time the recognition of certain physical defects and the dealing with them is, in many places, left largely or wholly to the teacher; and in some cities the director or teacher of gymnastics is more likely to develop into the true school physician, than is the medical inspector strictly so-called, therefore, in the present report we desire to call attention to the work to be done, and the ideals to be aimed at without elaborating any detailed system of organization, or distributing the specific duties among the school officers to whom they might be assigned. It is this design that is responsible for this apparent confusion of school inspection and supervision, of using as synonyms medical inspector and school physician, when evidently these terms may be properly used to indicate district officers. The work of medical inspection in the schools is directed obviously to three purposes: The (A) detection and limiting the spread of contagious diseases. (B) The study of physical defects and other departures from normal health in the scholar, with indication of the remedy. (C) Supervision of the scholar's environment; and to these may be added when we have fully qualified inspectors holding the right relations with other school authorities, (D) some supervision of the instruction regarding hygiene. The qualifications which this work demands of those who are to carry it on are: 1. Skill in diagnosis, the broadest and most difficult department in practical medicine. The diagnosis of disease is some thing that cannot be learned in fragments. Only to an extremely limited extent, and then with great uncertainty can any one disease be recognized, except by the person who can recognize all diseases. There are refinements of diagnosis which remain perforce chiefly in the hands of specialists, but every diagnostician knows that each extension of his ability to recognize a new pathological condition increases the certainty and exactness of his diagnosis of every condition. There is no diagnosis which is not differential. The recognition of the condition present demands that a host of other conditions be also borne in mind. 2. At least outline knowledge of what is required to meet each pathological condition discovered. Even if medical inspection in the schools dealt merely with contagious diseases, the duty would be well performed only by one who had received the greater part of a thorough medical education. In New York City, where the inspector is not allowed to mention the name of any physician or dispensary to the scholar, or even in general to make the slightest suggestion or criticism of treatment, they have been compelled to give with the exclusion cards full printed directions regarding the management of pediculosis, and to have a corps of trained nurses to send into the children's homes to see that certain skin diseases are efficiently treated. But the dealing with contagious disease is only of minor importance in school hygiene. It helps greatly to restrict the general morbidity of the community; but affects less the health of actual pupils than do conditions like eye-strain or imperfect general nutrition, that do not exclude the patient from the school room, If the object of school hygiene is the health of the children, almost every morbid condition that may affect the body should be recognized by the medical inspector and the needs of each particular case and the possible ways of meeting them intelligently appreciated. 3. The medical inspector of schools must have a broad, definite, practical knowledge of hygiene, including the factors which produce disease and those which guard against it. He must have some special knowledge with regard to the heating. lighting and ventilation of rooms and buildings, the disposal of refuse, disinfection, the general endurance of children and the signs of fatigue. The best medical supervision will go even fur ther than this and include an understanding of developmental and corrective physical training. Enough has been said to indicate that the medical inspector is simply a new specialization in the broad field of medicine. The training of the medical school, the actual treatment of patients, the quickening influence of medical journals and medical societies, are all essential to qualify one for such a line of work. Indeed, the efficiency of the inspector and the value of his work will depend to a considerable extent upon actual personal acquaintance with his colleagues in the medical profession, who practice in the district from which the scholars are drawn. He can only do his best to secure the health of the school, when, with the full advantage of the esprit d'corps of the medical profession, he is free to intrude as a friendly consultant upon any physician from whose families the scholars under his care may be drawn, with a freedom that is only possible to a recognized and friendly member of our profession. The thing that is required of us as members of the medical profession to-day is a frank, hearty recognition of this new specialty. Recognition of its importance, its scope, the difficulties necessarily encountered by those entering upon it, with the possibilities it offers of useful employment for a certain number of educated physicians, and of benefit to all other branches of the profession and the public at large. By drawing attention to existing remediable deformities and departures from normal health, there will be created a demand for skilled professional service, of the highest value to the community, and so of direct profit to our profession. The difficulties that have beset other specialists await the medical inspector, sometimes lessened, sometimes increased by the fact that he is working under the authority and in the pay of the general public, but always requiring the same intelligent appreciation of the rights of others, the same avoidance of unfriendly criticism, the same persistent endeavor to maintain a friendly relation that will bear the inevitable friction of contact through unintelligent and fault-finding patients. Let us recognize how much the medical inspector of schools has in common with the rest of us, entitling him or her to full participation in every privilege of our profession. Let us also recognize that if well-qualified for the special |