Health Work in the Public Schools | Page 8

to medical
inspection departments of other cities. A few of the rules adopted by
the staff will serve to indicate the nature of their work:
Teeth--Report decayed first or second teeth, and reddened and inflamed
gums. Do not report loose first teeth.
Tonsils--Report cases with histories of recurrent tonsilitis, and where
the size of the tonsils causes difficulty of swallowing or thick speech.
Do not report moderately enlarged tonsils with no history of tonsilitis
nor evidence of mechanical obstruction.
Adenoids--Report mouth breathers with characteristic adenoid faces,
convincing yourself as to diagnosis by having the pupil say "l, m, n, o,
p." Do not try to confirm the diagnosis of adenoids by a digital
examination of the nasopharynx.
Glands--Report general glandular enlargement and cervical
enlargement of the lymphatic glands accompanied by malnutrition and
anemia. Do not report submaxillary enlargement in recurrent tonsilitis
or carious teeth or post-cervical enlargement in pediculosis capitis, or
in impetigo or eczema of the scalp.
As a result of rules such as these, a given report means the same thing
to every member of the staff; only important defects are stressed; and
the effort to remedy them is concentrated where it will be most
effective. Statistics based on records such as these will be reliable and
may be used for scientific study.

VACCINATION
Thirteen years ago smallpox visited Cleveland. Twelve hundred and
forty-eight cases were reported. There were 30 cases of black smallpox.
Many of the patients were blinded or disfigured for life; 224 died. We
find in the annual report of the Board of Health for that year: "It was

the smallpox we read about, that terrible scourge which struck terror
into the former generations. Its contagious nature showed itself
everywhere. One case, if not promptly reported to the health office and
removed to the hospital, would invariably infect the whole
neighborhood. Its severity manifested itself even in the milder cases,
while confluent cases, almost without exception, developed
hemorrhages during the pustular state.... At the Mayor's request, a
meeting of physicians was held ... to consider the smallpox situation....
Vaccination was recommended on all sides, but the people were not
prone to get vaccinated.... Wholesale vaccination was finally effected
by the action of the School Council and the help of the Chamber of
Commerce. The School Council amended the vaccination clause,
making vaccination a conditio sine qua non for attending school and
giving the health officer the whole control of the matter. Without this
amendment the schools could not have opened last fall. The situation
was too critical. With it, the opening of the schools helped greatly to
exterminate smallpox. Every school, public and private, was put in the
charge of a physician.... The doctors worked with a will, and if
anything was done thoroughly and conscientiously in this city, it was
the vaccination of all teachers and pupils last fall.... Through the
influence of the Chamber of Commerce the employers prevailed on
their employees to get vaccinated. Also to have everyone of their
family vaccinated. The consequence was that the people got vaccinated
by tens of thousands. Men who formerly spurned the vaccinator from
their door came now to his office.... The city paid for 195,000
vaccinations."
In 1910 smallpox again broke out, this time in the southeastern part of
the city, and threatened to spread over the entire community. With
vivid memories of earlier horrors, the disease was met at the outset
with vigorous measures. It was discovered that in spite of the
experience of the Board of Education eight years before, and without
regard to the rule which provided that "No teacher or pupil shall attend
any school without furnishing satisfactory certificate that he or she has
been successfully vaccinated or otherwise protected from smallpox,"
unvaccinated children had been admitted to the public schools literally
by thousands. By the time that 63 cases of smallpox had been reported

the Board of Health again took matters into its own hands, entered the
schools, and vaccinated 55,000 school children. Equally vigorous
measures were taken among adults and the epidemic was checked.
Every year since 1910 there have been cases of smallpox in Cleveland.
The Board of Health no longer relies upon the Board of Education to
protect the lives of the community against the scourge. Where 70,000
children are gathered together daily for hours at a stretch, the
possibilities of spreading disease throughout the city at large constitute
a grave menace. Therefore, immediately upon the report of a case of
smallpox, the Board of Health officials exercise their right of entry into
the schools of that district, and either vaccinate or exclude from
attendance every child who could himself become a carrier of the
disease. During the present year over 1,400 children were vaccinated in
this way.
That vaccination prevents smallpox no intelligent person acquainted
with