The importance of the whole problem of nutrition can be made clear by quoting from the work of a specialist. The paragraphs selected are the more impressive because they show that other nations as well as ourselves are confronted by these problems.
Recently there has been an increasing tendency to make the report on nutrition of different children the basis of the entire medical-inspection report. This is because it has been demonstrated again and again that the occurrence of disease and physical defects is largely conditioned by nutritional disturbances.
In Paris medical inspectors have charge of the school canteens and are required to report on the nutrition of each child. They are further expected to follow up any child with impaired nutrition and to administer tonics and special care.
In England, since 1907, compulsory medical inspection has included inspection of nutrition. Beginning with 1909, the chief medical officer of the National Board of Education has reported yearly on the nutrition of the children throughout the country and on the work of the school feeding centers. In Scotland the medical inspectors are required to see that children suffering from malnutrition are fed properly either by the school or by the parents. As a result of this systematic work British school doctors are developing methods of technique and standards for judging malnutrition, which, on account of its complex and interwoven causes, is very difficult to estimate accurately....
In American cities no record of the nutrition of the entire school population has been made. In 1907 in New York the Committee on Physical Welfare of School-Children reported 13 per cent of 990 children, selected as typical of the whole city, to be suffering from malnutrition. A similar investigation of 10,090 children in Chicago in 1908 revealed 12 per cent badly nourished in all grades, the proportion decreasing from 15 per cent in the kindergarten to 6 per cent in the fifth grade and above. Wherever an attempt has been made to include all classes of children in the examinations, the percentages found suffering from acute malnutrition run from 10 to 15. Where only schools in the poorer districts are included, the percentages are far higher, and vary between 20 and 40. However, it must be remembered that children from the poorer districts far outnumber those in other schools, so that in point of figures the actual proportion of children suffering from malnutrition is probably nearer the second estimate. Doctor Thomas F. Wood, of Columbia, gives 25 per cent as the estimate for the school population of the whole country.
“The longer a medical officer remains at school inspection,” remarks Doctor Hope, of Liverpool, in a report for 1912, “the more severe becomes his standard of nutrition, and the less readily does he pass a child as being well nourished.”[89]
One reason that health conditions in rural schools have been so long neglected is because of the common idea that country children are naturally vigorous and healthy. “This ought to be so but unfortunately is not,” says Doctor Ernest Hoag, in a recent government report. He finds that, “in general, food is not as well prepared in the country as it is in the city; the available variety is smaller.” Bad methods of ventilation and heating at home and at school, exposure to wet in the long walks to school, and overdressing in the house—all are inroads on the already badly nourished bodies. Investigations show that malnutrition and its accompanying diseases are quite as frequent among country as among city children.[90]
Control of Contagion
Turning from nutrition to another aspect of the physical condition in schools, it is easy to show that the school must control contagion. The bringing together of hundreds of children increases so greatly the probability of spread of disease that the health authorities always welcome the arrival of the summer vacation as a relief from the most strenuous of their duties.
The School Health Department
The kinds of demands described have led to the development of health departments in many school systems. The various functions served by a school health department have been described by Dr. E. A. Peterson, a health officer in one of the largest cities of the country, in a report from which the following paragraphs are extracted:
The problem of checking contagion is an acute problem in the schools. The facts show that in the early years of a child’s school life he has more of the diseases of childhood than at any other period, especially more than he had when he was at home during the period immediately preceding school. Furthermore, as soon as school breaks up for the long vacation, contagion subsides. The bringing together of large groups of children in schools is one of the most prolific methods of spreading contagion....
But the school health service soon developed far beyond this first stage of merely policing the schools. Indeed, one sees the real justification of a separate school health department if he follows this health department into what may be called its second, third, and final stage of evolution....
Examinations by physicians within the last decade indicate that as many as five per cent of school children suffer from defective vision to such an extent that they cannot see lessons on the board unless they have the services of expert oculists, that one in every hundred cannot hear what the teacher is saying, that ten in every hundred are so “stopped up” by adenoids that attention to school work is nearly impossible until the science of medicine gives them relief.
This drew the attention of the educational world to the necessity of ridding children of these defects in order that they may take advantage of the educational opportunity offered in the schools....
One characteristic development shown at this second stage of school health organization is the employment of the school nurse. The school nurse marks the growth of the health era away from its first or merely policing stage. The school nurse is at once a medical officer and a teacher. She teaches the parents in the home and she teaches the children. She becomes a most important link between the home and the school. Her methods are those of persuasion, not those of the emergency police officer....
Once the idea of making health a matter of intelligent interest took root, it was sure to grow. Correction of physical defects is itself a tardy method of dealing with the situation. Why not prevent the defects? This kind of thinking turned attention to the environment of the child and the necessity of making it as conducive to health as possible....
Finally, it is by no means satisfactory that we should stop with the negative work of preventing disease and unfavorable conditions. We must be positive in our treatment of health. We want more health, more vigor, more efficiency. The fourth stage of medical inspection may properly be called the health development stage and has to do not only with the teaching of hygiene but with the development of higher ideals of wellness, with the raising of the standard of normality, with taking a person who is well and making him “wellest.”...
The department must constantly assume new functions without dropping any of the old. If it is to be an efficient department, it must carry on all of the activities suggested in the summary which can be made up from the foregoing study.
First stage—Inspection
1. Inspection of children for contagious diseases
Second stage—Discovering and correcting defects
2. Physical examination of all children
3. Follow-up work in the home to get corrections
4. Maintenance of school clinics
Third stage—Prevention
5. Sanitary inspection Hygiene of building Hygiene of curriculum Hygiene of instruction Special schools for special cases 6. Examination and inspection of principals, teachers, janitors and other employees
Fourth stage—Health development
7. Health teaching at school and at home
8. Establishing health habits by means of
- a. Toothbrush drills
- b. Handkerchief drills
- c. Bathing, etc.
- d. Health clubs[91]
1. Inspection of children for contagious diseases
2. Physical examination of all children
3. Follow-up work in the home to get corrections
4. Maintenance of school clinics