Page images
PDF
EPUB

State expenditures for school health services for the last school year for which statistics are available, 1943–44, compiled by U. S. Office of Education—Con.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][subsumed][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

Mr. DOLLIVER. We will also include Public Health Nursing Service to School Children in Selected Cities.

(The document is as follows:)

PUBLIC HEALTH NURSING SERVICE TO SCHOOL CHILDREN IN SELECTED CITIES

(Research Department District of Columbia Tuberculosis Association, July 1947 (revised)

Of

In order to determine the amount of public health nursing service available in schools, the advisory committee on school health of the District of Columbia Tuberculosis Association sent a questionnaire to the health department of 108 cities in the United States. Seventy-one questionnaires were returned. these, 18 could not be used because they were incomplete or received too late for inclusion in the tabulation. Information concerning public and private schools, public schools only, or private schools only was returned on the 53 questionnaires included in the tabulation. Information from 15 cities covered both public and private schools; 33 cities returned information on public schools only; 5 gave information on private schools only.

Of the cities giving information for both public and private schools, Jersey City had the highest ratio of nurses to school children (1 nurse to 618 school children) and Washington, D. C., the lowest ratio of nurses to school children (1 nurse to 6,800 school children). Rochester, N. Y., had the highest ratio of nurses to school children (1 to 881.6) in those cities reporting public schools only, and St. Louis, Mo., the lowest ratio of nurses to school children (1 to 7,131.4).

[graphic]

Public health nursing service to school children in selected cities

[ocr errors]

22. Yonkers, N. Y

23. Cambridge, Mass.

24. Akron, Ohio.

25. Wilmington, Del.

26. Youngstown, Ohio.

27. Denver, Colo

28. Utica, N. Y....

29. Lowell, Mass..

30. Dallas, Tex.5

[ocr errors]
[ocr errors]

31. Salt Lake City, Utah.

33. Springfield, Ill.

33. Salem, Mass.

34. St. Paul, Minn.

[ocr errors]
[ocr errors]
[ocr errors]
[ocr errors]
[blocks in formation]
[subsumed][subsumed][subsumed][subsumed][ocr errors][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed]

1 Total figures given only when data is complete for public and private schools.

[blocks in formation]
[graphic]

Public health nursing service to school children in selected cities-Continued

[ocr errors]
[ocr errors]
[ocr errors]
[ocr errors]

1 Total figures given only when data is complete for public and private schools.

2 Parochial schools included.

12 schools do not have service due to shortage of staff.

15 public health nurses assigned to school service, Dec. 2, 1946.

7 Subsequent information indicates that San Francisco, Calif., has 46 nurses assigned to schools, therefore San Francisco ranks thirtieth on this list of 53 cities.

Source: Research Department, District of Columbia Tuberculosis Association, December 1946. Based on data collected by the advisory committee on school health, District of Columbia Tuberculosis Association.

Mr. DOLLIVER. The other articles, including the magazine article, and the editorials, will be used as exhibits in connection with the testimony.

There have been a number of organizations and individuals who have written to the chairman of this subcommittee asking that their communications be inserted in the record, and it will be done at this

point.

This is a letter from James L. Wilson, who is a professor of pediatrics and communicable diseases at the university hospital, University of Michigan, Ann Arbor.

(The letter is as follows:)

UNIVERSITY OF MICHIGAN,
UNIVERSITY HOSPITAL,

DEPARTMENT OF PEDIATRICS AND COMMUNICABLE DISEASES,
Ann Arbor, July 8, 1947.

Representative CHARLES A. WOLVERTON,

Chairman, Interstate and Foreign Commerce Commission,
House of Representatives Office Building, Washington, D. C.

DEAR SIR: I have been asked to write to you to urge the passage of the bill (H. R. 1980), called national school health service bill. I am sorry that I cannot approve the bill as I understand it. There is plenty of good that can be done by school health activities, but I think those who are trying to effect this good should be more thoroughly acquainted than they seem to be with the actual details of medical care of well and of sick children. I believe that the physicians and pediatricians on whom we must depend for these purposes should have a voice in the practical administration of any such bill and I do not see that that is provided for.

I do not believe that the bill will accomplish what is hoped for by its very sincere proponents. I believe that it will be wasteful of tax money and will build up another organization which will tend to be self-perpetuating regardless of its effectiveness. I do not believe the bill as written clearly defines its own purpose in respect to the actual practical implementation of the bill and that before any such thing is passed a great deal more study by people more sophisticated in this specific problem involved should be carried out. The proponents of the bill from the literature, which I have describing it, seem to me lack experience and are rather naive and only stimulated by eagerness for social planning.

One might first define what is being accomplished by present efforts at school health. In general they consist only of a physical examination which detects certain physical handicaps and advises their correction, but no machinery is provided for following up the advice. One should clearly understand the limitations of a physical examination in childhood. By itself it will not accomplish a great deal, and it often does harm by giving a false sense of security to parents who think their children have been thereby given medical attention. Although physical examination can pick up certain serious defects and many more not-so-serious ones, such as cavities in teeth, hernia, and poor posture, it should be considered a basic principle in medical practice that a thorough his*ory and consultation with parents of children should be carried out at the same time and physical examination and by the same person. It is dangerous and wasteful and entirely illogical to have physical examination separated from conference with parents and to have either of those separated from the actual giving of advice for the carrying out of therapeutic or preventive procedurés. In the present bill it is proposed that these faults in school-health activities should be corrected by better follow-up. In that case it should be very clear that the bill proposes that in the school system the actual practice of medicine be carried out. If that is to be done, then certain results should be stated very clearly and their difficulties honestly faced. The Government would thereby get involved in the actual practice of medicine in competition with private practice. Under these circumstances immensely more money than the twelve to eighteen million dollars proposed would be necessary, or else a means test would be necessarily provided so that these governmental medical services could be given only to those who were in a certain income or social group. It is proposed that this bill be administered by the Children's Bureau who have expressed themselves again and again as opposed to the general principle of a means test.

This difficulty should be faced. Either we have a national scheme to carry out medical care for all children or a limited one depending upon some means test.

If it is proposed by this bill that full-time physicians be employed to carry out its activities; then another problem needs to be faced, and it should be faced by Congress, anyway. The salaries that can be offered, however, are entirely inadequate to compete with what can be earned in private practice or even in ordinary academic medicine. The result is that only women or very young men or older men who have experienced difficulties in practice or have other handicaps are employed. Young medical graduates with only a year of pediatric training are being employed by State health departments as consultants, an arrangement which only casts Government medicine further into disreput. If it is proposed in this bill that physicians should be hired, then it should be made clear right away that good ones should be hired or the project should not be entered into at all.

In support of the bill a great point is made of the high percent of physically and mentally unfit that were discovered by the draft for the last war. The implication is made, and the fact clearly stated, that these defects should have been discovered and corrected when it was possible in the early school years. The popular analysis of the draft figures of health examination is quite unrealistic and is quite distorted by the lay people who tried to interpret them. I cannot go through all the figures, but a little break-down might be of value. A great many people were rejected and are listed as being physically unfit because of dental caries. Dental caries can easily be discovered by a school examination. Dental caries, however, is so universally present, certainly more than 90 percent of children being sufferers of that condition, that a preliminary examination is hardly necessary. What is necessary is either to correct or prevent dental caries. In the regard to the first, only one thing is practical, and that is to educate and hire more dentists to fill teeth. A direct appropriation for this purpose might well be in order. It is very clear, however, that there just are not anywhere near enough dentists to fill the teeth of all our children, if any concerted effort was made to correct their faults.

We could ask, Why not prevent dental caries. The answer is that medical science does not know yet how to correct dental caries, although it is evident that improvement of general health and nutrition does reduce the incidence of it. Therefore we should direct our attention to the general improvement of health and nutrition, but at present there are no specific steps that can be taken to do so, and the problem is completely tied up with the whole economic status of our citizens.

Much is made of the mentally unfit and yet we must realize very clearly that so far we have no specific dependable measures to avoid the mental ill healths which we discover in adult life. In spite of the philosophical writings of many enthusiastic proponents of mental hygiene, we still are in a nebulous stage of development when it comes to specific preventive procedures. All we can say is that we should make children and their parents as happy as possible. But again this problem is bound up in the social and economic happiness of our people and cannot be attacked realistically by a twelve or eighteen million dollar program carried out through schools. Hernia which can be discovered by physical examination can of course be corrected by surgical means, but are not important during the school age that this bill proposes to cover.

I do not mean to imply, however, that a great deal cannot be done by school health activities. Certainly detection of refractive errors in the eye and of deafness can be efficiently carried out by physical examination alone and in groups of school children. It seems to me that such activities as are now being carried on by school health in programs in various States might be well encouraged within moderate limits and certainly with the knowledge of the great limitations of such activities but I do not think that the bill as written with the purposes as described is necessary for the accomplishment of these limited ends.

There are many medical faults that could be attacked by congressional action. It might be well to realize that the money suggested for appropriation for this school health services bill is some 10 times as much as is spent in this country in all the medical schools in the training programs of undergraduate, graduate, and postgraduate activities in pediatrics. There is an enormous shortage of pediatricians and people are only now beginning to realize that men specially trained in the care of infants and children are valuable as general physicians and not simply as consulting specialists.

« PreviousContinue »