Health Work in the Public Schools | Page 7

of the Visiting Nurses Association 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 Saturday, 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
glasses. 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 classes
by nurses last year, we have 1,260 talks by physicians and 4,431 by
nurses to classes in 1914-1915.
This method of varied problems is unquestionably effective in
promoting growth and maintaining interest on the part of the staff. Care

should be taken, however, to provide that within each four-year
period--twice during the eight years of school life--special emphasis be
laid upon the discovery and cure of each of the more important defects.
How this emphasis should be distributed is a matter best decided by the
staff in conference. It might be found advisable to adopt a plan whereby
special attention is given to teeth, adenoids, tonsils, and glands in the
lower grades; posture and heart in the upper grades; and eyes, hearing,
lungs, and nutrition straight through the grades. Whatever plan is
adopted must be the result of study, consultation, and experiment, in an
endeavor to find the most economical investment of effort on the part
of nurses and doctors in terms of results gained.
[Illustration: Columns are proportionate in height to the per cent of
physical defects corrected each year for five school years.]
Speech defects are very common among children. At first they yield
readily to treatment, but if allowed to continue through the adolescent
period the habit becomes fixed so that trying to cure it is a difficult and
often fruitless task. Judging from the experience of other cities, about
200 boys and 800 girls in the Cleveland public school system are
suffering from some form of speech defect. There are few fields in
which the medical inspection department has such an opportunity for
effective work and in which so little has been done. Effort should be
made to locate these children, and form them into groups for daily
training, under the direction of a teacher specially prepared to handle
speech cases.

UNIFORM PROCEDURE
In the fall of 1914, the medical staff conducted a survey of its own
efficiency. A committee prepared questions concerning procedure, and
secured answers from each member of the staff. These answers were
compared and discussed in staff meetings and uniform rules were
finally adopted for examinations and recording.
In line with this, the staff somewhat earlier prepared rules for reporting

defects so that all records may be compiled on the same basis. This
standardization of work is an especially noteworthy feature of the
Cleveland system, and should furnish valuable suggestions