,,cleveland ,,education ,,survey        
,,health ,,work ,,in     ,,the ,,public 
,,schools      ,,leonard ,p4 ,,ayres    
,,and     ,,may ,,ayres                 
,illustration3 ,,cfs       ,,the        
,,survey ,,committee ,,of ,,the         
,,cleveland ,,foundation     ,,cleveland
  ,,ohio           #aiae                
,,copyright1 #aiae1 ,,by      ,,the     
,,survey ,,committee ,,of ,,the         
,,cleveland ,,foundation       ,,wm,f4  
,,fell ,,co,,printers     ,,philadelphia
       ,,the ,,survey ,,committee ,,of  
,,the     ,,cleveland ,,foundation      
,charles ,e4 ,adams1 ,chairman          
,thomas ,g4 ,fitzsimons     ,myrta ,l4  
,jones     ,bascom ,little     ,victor  
,w4 ,sincere      ,arthur ,d4 ,baldwin1 
,secretary     ,james ,r4 ,garfield1    
,counsel     ,allen ,t4 ,burns1         
,director      ,,the ,,educational      
,,survey     ,leonard ,p4 ,ayres1       
,director  ,illustration3 ,team work    
between physician and nurse in          
,cleveland4     ,,foreword   ,this      

report on ,health ,work in the ,public  
,schools is one of the #be sections of  
the report of the ,educational ,survey  
of ,cleveland conducted by the ,survey  
,committee of the ,cleveland ,foundation
 in #aiae4 ,twenty-three of these       
sections will be published as separate  
monographs4 ,in addition there will be a
 larger volume giving a summary of the  
findings and recommendations relating to
 the regular work of the public schools1
 and a second similar volume giving the 
summary of those sections relating to   
industrial education4 ,copies of all    
these publications may be obtained from 
the ,cleveland ,foundation4 ,they may   
also be obtained from the ,division of  
,education of the ,russell ,sage        
,foundation1 ,new ,york ,city4 ,a       
complete list will be found in the back 
of this volume1 together with prices4   
,,table ,,of ,,contents                 
,,page     ,foreword                    
#e     ,list of ,illustrations and      
,diagrams                               

#i     ,the ,argument for ,medical      
,inspection                             
#aa     ,health and ,school ,progress   
#ac     ,examinations for ,physical     
,defects                                
#ad     ,objections to ,medical         
,inspection                             
#af     ,how the ,work ,started         
#ah     ,the ,present ,system           
#bj     ,the ,school ,nurse             
#ba     ,cleveland's ,dispensaries      
#bd     ,dental ,clinics                
#bh     ,eye ,clinics                   
#cj     ,co-operation of ,college for   
,barbers                                
#cb     ,the ,medical ,inspection ,staff
                                     #cb
     ,the ,plan of ,concentrating       
,interests                              
#cd     ,uniform ,procedure             
#cg     ,vaccination                    
#ci     ,future ,development            
#dc     ,ten ,types of ,health ,work    
#df     ,health and ,education and      
,business                               

#dh     ,summary                        
#ed                          ,,list ,,of
 ,,illustrations                        
,,facing                                
,,page      ,team work between physician
 and nurse in ,cleveland4  ,frontispiece
     ,tony's tonsils need attention     
#ag     ,either doctor or nurse visits  
every school every day             #bj  
,cleveland's dispensaries are well      
equipped                       #be      
,the equipment of the ,marion ,school   
dental clinic cost about #gjj #bh       
,the eye clinic is advertised by its    
loving friends               #ca        
,vaccinated children at ,hodge          
,school--#ej1jjj more are               
unvaccinated                            
#ci     ,shower baths installed in an   
old building in a crowded section   #dd 
,,diagrams      ,number of children     
given physical examinations each year   
for         five school years and number
 found to have physical defects  #bf    
,per cent of physical defects corrected 

each year for five         school years 
#cf     ,,health ,,work ,,in ,,the      
,,public ,,schools   ,cleveland employs 
#af physicians1 one oculist1 and #bg    
nurses to take charge of the health of  
her school children4 ,the city spends   
#cf1jjj a year on salaries and supplies 
for these people4 ,there are #hf school 
dispensaries and clinics4 ,cleveland is 
making this heavy investment because she
 finds it pays4     ,,the ,,argument    
,,for ,,medical ,,inspection   ,medical 
inspection is an extension of the       
activities of the school in which the   
educator and the physician join hands to
 insure for each child such conditions  
of health and vitality as will best     
enable him to take full advantage of the
 free education offered by the state4   
,its object is to better health         
conditions among school children1       
safeguard them from disease1 and render 
them healthier1 happier1 and more       
vigorous4 ,it is founded upon a         
recognition of the intimate relationship

 between the physical and mental        
conditions of the children1 and the     
consequent dependence of education on   
health conditions4  ,in ,cleveland1 the 
value of medical inspection was         
recognized while the movement was still 
in its infancy in ,america4 ,here1 as   
elsewhere1 this sudden recognition of   
the imperative necessity for            
safeguarding the physical welfare of    
school children grew out of the         
discovery that compulsory education     
under modern city conditions meant      
compulsory disease4  ,the state1 to     
provide for its own protection1 has     
decreed that all children must attend   
school1 and has put in motion the       
all-powerful but indiscriminating agency
 of compulsory education1 which gathers 
in the rich and the poor1 the bright and
 the dull1 the healthy and the sick4    
,the object was to insure that these    
children should have sound minds4 ,one  
of the unforeseen results was to insure 
that they should have unsound bodies4   

,medical inspection is the device       
created to remedy this condition4 ,its  
object is prevention and cure4  ,ever   
since its establishment the good results
 of medical inspection have been        
evident4 ,epidemics have been checked or
 avoided4 ,improvements have been noted 
in the cleanliness and neatness of the  
children4 ,teachers and parents have    
come to know that under the new system  
it is safe for children to continue in  
school in times of threatened or actual 
epidemic4     ,,health ,,and ,,school   
,,progress   ,but medical inspection    
does not confine itself to dealing with 
contagious disease4 ,its aid has been   
invoked to help the child who is        
backward in his school studies4 ,with   
the recent extensions in the length of  
the school term and the increase in the 
number of years of schooling demanded of
 the child1 has come a great advance in 
the standards of the work required4     
,when the standards were low1 the work  
was not beyond the capacity of even the 

weaker children2 but with close grading1
 fuller courses1 higher standards1 and  
constantly more insistent demands for   
intellectual attainment1 conditions have
 changed4 ,pupils have been unable to   
keep up with their classes4 ,the terms  
backward1 retarded1 and exceptional1 as 
applied to school children1 have been   
added to the vocabularies of educators4 
,school men discovered that the drag-net
 of compulsory education was bringing   
into school hundreds of children who    
were unable to keep step with their     
companions1 and because this interfered 
with the orderly administration of the  
school system1 they began to ask why the
 children were backward4  ,the school   
physicians helped to find the answer    
when they showed that hundreds of these 
children were backward simply because of
 removable physical defects4 ,and then  
came the next great forward step1 the   
realization that children are not       
dullards through the will of an         
inscrutable ,providence1 but rather     

through the law of cause and effect4    
,,examinations ,,for ,,physical         
,,defects   ,this led to an extension of
 the scope of medical inspection to     
include the physical examination of     
school children with the aim of         
discovering whether or not they were    
suffering from such defects as would    
handicap their educational progress and 
prevent them from receiving the full    
benefit of the free education furnished 
by the state4 ,this work was in its     
infancy five years ago1 but today       
,cleveland has a thorough and           
comprehensive system of physical        
examination of its school children4     
,surprising numbers of children have    
been found who1 through defective       
eyesight1 have been seriously           
handicapped in their school work4 ,many 
are found to have defective hearing4    
,other conditions are found which have a
 great and formerly unrecognized        
influence on the welfare1 happiness1 and
 mental vigor of the child4 ,attention  

has been directed to the real           
significance of adenoids and enlarged   
tonsils1 of swollen glands and carious  
teeth4  ,teachers and parents have come 
to realize that the problem of the pupil
 with defective eyesight may be quite as
 important to the community as that of  
the pupil who has some contagious       
disease4 ,if a child who is unable to   
see distinctly is placed in a school    
where physical defects are unrecognized 
and disregarded1 headaches1 eyestrain1  
and failure follow all his efforts at   
study4 ,he cannot see the blackboards   
and charts2 printed books are indistinct
 or are seen only with much effort1     
everything is blurred4 ,neither he nor  
his teacher knows what is the matter1   
but he soon finds it impossible to keep 
pace with his companions1 and1 becoming 
discouraged1 he falls behind in the     
unequal race4  ,in no better plight is  
the child suffering from enlarged       
tonsils and adenoids1 which prevent     
proper nasal breathing and compel him to

 keep his mouth open in order to        
breathe4 ,perhaps one of his troubles is
 deafness4 ,he is soon considered       
stupid4 ,this impression is strengthened
 by his poor progress in school4        
,through no fault of his own he is      
doomed to failure4 ,he neglects his     
studies1 hates his school1 leaves long  
before he has completed the course1 and 
is well started on the road to an       
inefficient and despondent life4        
,public schools are a public trust4     
,when the parent delivers his child to  
their care he has a right to insist that
 the child under the supervision of the 
school authorities shall be safe from   
harm and shall be handed back to him in 
at least as good condition as when it   
entered school4 ,even if the parent does
 not insist upon it1 the child himself  
has a right to claim protection4 ,the   
child has a claim upon the state and the
 state a claim upon the child which     
demands recognition4 ,education without 
health is useless4 ,it would be better  

to sacrifice the education if1 in order 
to attain it1 the child must lay down   
his good health as a price4 ,education  
must comprehend the whole man and the   
whole man is built fundamentally on what
 he is physically4     ,,objections ,,to
 ,,medical ,,inspection   ,the objection
 that the school has no right to permit 
or require medical inspection of the    
children will not bear close scrutiny or
 logical analysis4 ,the authority which 
has the right to compel attendance at   
school has the added duty of insisting  
that no harm shall come to those who go 
there4 ,the exercise of the power to    
enforce school attendance is dangerous  
if it is not accompanied by an          
appreciation of the duty of seeing to it
 that the assembling of pupils brings to
 the individual no physical detriment4  
,illustration3 ,tony's tonsils need     
attention4  ,nor are the schools1 in    
assuming the medical oversight of the   
pupils1 trespassing upon the domain of  
private rights and initiative4 ,under   

medical inspection1 what is done for the
 parent is to tell him of the needs of  
his child1 of which he might otherwise  
have been in ignorance4 ,it leaves to   
the parent the duty of meeting those    
needs4 ,it leaves him with a larger     
responsibility than before4 ,it is      
difficult to find a logical basis for   
the argument that the school has not the
 right to inform the parents of defects 
present in the child1 and to advise as  
to remedial measures which should be    
taken to remove them4  ,the             
justification of the state in assuming  
the function of education and in making 
that education compulsory is to insure  
its own preservation and efficiency4    
,whether or not it is successful will   
depend on the degree to which its       
individual members are spiritually      
prepared for modern co-operation4  ,but 
the well-being of a state is as much    
dependent upon the strength1 health1 and
 productive capacity of its members as  
it is upon their knowledge and          

intelligence4 ,in order that it may     
insure the efficiency of its citizens1  
the state1 through its compulsory       
education enactments1 requires its youth
 to pursue certain studies which        
experience has proved necessary to      
secure that efficiency4 ,individual     
efficiency1 however1 rests not alone on 
education or intelligence1 but is       
equally dependent on physical health and
 vigor4 ,hence1 if the state may make   
mandatory training in intelligence1 it  
may also command training to secure     
physical soundness and capacity4 ,health
 is the foundation on which rests the   
happiness of a people and the power of a
 nation4     ,,how ,,the ,,work         
,,started   ,the first work of this kind
 in ,cleveland is described in          
,superintendent ,jones' report for      
#aijj4 ,in that year the schools became 
greatly interested in the question of   
defective vision4 ,tests were made by   
teachers in different grades1 and as a  
result over #b1jjj children were given  

treatment4  ,in #aijf1 an agreement was 
reached with the ,board of ,health1 so  
that each alternate day a health        
inspector communicated with the         
principal of every school4 ,teachers    
were warned to be on the alert for      
symptoms of illness1 and children       
showing signs of measles1 whooping      
cough1 scarlet fever1 or other common   
diseases of childhood1 were reported to 
the principal1 and through her to the   
,board of ,health4 ,contagious cases    
were excluded from school as soon as    
detected1 and a systematic campaign     
started against the waves of disease    
which were sweeping one after another   
through the schools4  ,in the same year 
,drs4 ,l4 ,w4 ,childs1 ,j4 ,h4          
,mc,henry1 ,h4 ,l4 ,sanford1 and other  
members of the medical profession       
volunteered their services as school    
physicians1 to detect not only cases of 
possible contagion1 but also the        
existence of physical defects4 ,what was
 probably the first school dispensary in

 the ,united ,states was opened at the  
request of ,dr4 ,childs by the ,board of
 ,education in #aijg at the ,murray     
,hill ,school4 ,the value of school     
dispensaries was so immediately evident 
that by #aiji seven others were         
established for the use of these three  
physicians4  ,coincident with the       
dispensaries came the school nurse4     
,when the first nurse was appointed at  
the ,murray ,hill ,school1 a remarkable 
change was observed among the children4 
,absences became less frequent4 ,skin   
diseases were rare4 ,children began to  
take an interest in health matters1 and 
there was a marked rise in standards of 
neatness and cleanliness4 ,teachers and 
principals united in their demand for   
more nurses1 until within a year after  
the movement started there were six     
nurses appointed by the ,board of       
,education and regularly employed in    
school work4 ,in the same year1         
,december1 #aiji1 the ,board of         
,education formally voted to establish a

 ,division of ,health ,supervision and  
,inspection as part of the regular      
school system4     ,,the ,,present      
,,system   ,as it is at present         
organized1 the ,division handles        
inspection for contagious disease1      
inspection for physical and mental      
defects1 follow-up work for the         
remedying of defects1 health            
instruction1 recommendation of children 
to schools for the physically and       
mentally handicapped1 school lunches1   
gardens1 and playgrounds4  ,either the  
nurse or physician reports at each      
school every day of the year4 ,once     
during the year each child is given a   
careful physical examination1 and       
further examinations are made when they 
are needed4 ,all serious defects are    
reported to parents1 and in cases where 
treatment is important1 parents are     
urged to consult with the school doctor 
concerning the nature of the difficulty 
and the best means of curing it4 ,to    
supplement these interviews1 the school 

nurse spends a large part of her time in
 visiting homes1 talking with parents1  
noting conditions under which children  
live1 and making suggestions as to home 
care4  ,illustration3 ,either doctor or 
nurse visits every school every day4    
,some idea of the complexity of this    
work may be gained from the ,division   
records for #aiad-aiae4 ,from the       
beginning of ,september to the end of   
,june--a period of #ch school           
weeks--doctors and nurses examined      
#gd1gbe children2 gave private          
interviews to #b1edg parents2 made      
#e1fge visits to dispensaries2 #aj1fjc  
visits to homes2 and gave #gf1bdj       
treatments and dressings4 ,in addition1 
they gave #gge toothbrush drills1 and   
#ai1djf individual or class health talks
 to the pupils of the public schools    
during the year4     ,,the ,,school     
,,nurse   ,the value of the school nurse
 is one feature of medical inspection of
 schools about which there is no        
division of opinion4 ,her services have 

abundantly demonstrated their utility1  
and her employment has quite passed the 
experimental stage4 ,the introduction of
 the trained nurse into the service of  
education has been rapid1 and few school
 innovations have met with such         
widespread support and enthusiastic     
approval4  ,the reason for this is that 
the school nurse supplies the motive    
force which makes medical inspection    
effective4 ,the school physician's      
discovery of defects and diseases is of 
little use if the result is only the    
entering of the fact on the record card 
or the exclusion of the child from      
school4 ,the notice sent to parents     
telling of the child's condition and    
advising that the family physician be   
consulted1 represents wasted effort if  
the parents fail to realize the import  
of the notification or if there be no   
family physician to consult4 ,if the    
physical examination has for its only   
result the entering of words upon record
 cards1 then pediculosis and            

tuberculosis are of precisely equal     
importance4 ,the nurse avoids such      
ineffective lost motions by converting  
them into efficient functioning through 
assisting the physician in his          
examinations1 personally following up   
the cases to insure remedial action1 and
 educating teachers1 children1 and      
parents in practical applied hygiene4   
,some idea of the work of the school    
nurses in ,cleveland may be gained from 
the following record of what one nurse  
did during one day while the survey was 
in progress4 ,it represents a typical   
day's work for a typical nurse and is   
not especially unusual4       #h3cj ,a4 
,m4       ,home call to get permission  
to take child to school                 
headquarters for mental examination4    
,called at ,case-,woodland ,school to   
examine child with sore      throat4    
,took a child home to have mother clean 
her up4       ,called at ,harmon        
,school4       ,treated #aj cases of    
impetigo1 three of toothache1 two of    

ringworm4       ,took two children home 
to be cleaned up4       ,inspected #ej  
children4       ,gave health talk4      
,tried to locate a boy who is to attend 
partial blind class      at ,harmon     
,school4       ,found boy was           
transferred from ,harmon ,school to     
,marion      ,school last year4         
,called at ,marion ,school but found no 
trace of boy4       ,called at address  
to which child was supposed to have     
moved2      no such number4             
,called at ,kennard ,school to see if   
,miss ,o',neill remembered      him at  
,marion ,school2 found no trace of him4 
,called at two homes in regard to       
enlarged tonsils and      defective     
vision4       #a3ae ,p4 ,m4             
,mayflower ,school3 boy with sprained   
ankle1 soaked in hot      water1        
strapped with adhesive4       ,treated  
four cases of impetigo1 one cut finger1 
opened two      boils4       ,conference
 with mother at school4                 
,instructed her in case of child's      

discharging ear4       ,inspected #fb   
children4       ,called at two homes to 
secure treatment for defective teeth4   
,advised mother to send children to     
,marion ,dental ,clinic4  ,to sum up the
 case for the school nurse3 ,she is the 
teacher of the parents1 the pupils1 the 
teachers1 and the family in applied     
practical hygiene4 ,her work prevents   
loss of time on the part of the pupils  
and vastly reduces the number of        
exclusions for contagious diseases4 ,she
 cures minor ailments in the school and 
clinic and furnishes efficient aid in   
emergencies4 ,she gives practical       
demonstrations in the home of required  
treatments1 often discovering there the 
source of the trouble1 which1 if        
undiscovered1 would render useless the  
work of the medical inspector in the    
school4 ,the school nurse is the most   
efficient possible link between the     
school and the home4 ,her work is       
immensely important in its direct       
results and far-reaching in its indirect

 influences4 ,among foreign populations 
she is a very potent force for          
,americanization4     ,,cleveland',s    
,,dispensaries   ,cleveland has #hf     
school dispensaries1 or what are usually
 termed physicians' offices4 ,these are 
rooms about #bj feet long by #ae feet   
wide1 located in the basement or on the 
first floor of the school building1 well
 lighted1 and painted in white or light 
colors4 ,usually they contain one or two
 small white enamel tables1 several     
chairs1 a wash basin with running water1
 a white enamel pail for waste          
materials1 wooden tongue depressors1 eye
 charts1 a medical cabinet filled with  
instruments and supplies1 filing boxes1 
and printed forms4 ,in #cg of the       
elementary schools1 shower baths are    
provided as part of the equipment of the
 building4  ,illustration3 ,cleveland's 
dispensaries are well equipped4         
,cleveland's dispensaries are of        
exceptionally high grade4 ,in every case
 lighting1 ventilation1 and equipment   

are good4 ,many of the rooms are large  
enough for conferences and hygiene      
talks1 and in at least one school--,east
 ,madison--the dispensary is used with  
desirable psychological effect for the  
regular meetings of the ,mothers' ,club4
 ,the excellence of ,cleveland's school 
dispensaries has contributed in no small
 measure to the efficiency of the       
medical service1 and money spent in this
 way has been a wise investment4 ,it is 
probably true that ,cleveland's         
dispensaries are of better grade than   
those of any other large city in the    
,united ,states4  ,illustration3        
,columns are proportionate in height to 
the number of children given physical   
examinations each year for five school  
years4 ,portion in black indicates      
number having physical defects4 ,the    
figures above the columns show how many 
thousands of children were examined and 
how many found defective in each year4  
,these dispensaries have proved of the  
greatest value in rendering the physical

 examinations of the children more      
effective and efficient4 ,this work is  
very different from that which relates  
to the detection of contagious diseases4
 ,the latter is primarily a protective  
measure and looks mainly to the         
immediate safeguarding of the health of 
the community4 ,the former aims at      
securing physical soundness and vitality
 and looks far into the future4  ,the   
physical examinations conducted in these
 dispensaries have shown conclusively   
that a large percentage of the          
,cleveland children--like those of all  
other cities--suffer from defective     
vision to the extent of requiring an    
oculist's care if they are to do their  
work properly1 and if permanent injury  
to their eyes is to be avoided4 ,more   
than this1 a considerable proportion of 
the children are so seriously defective 
in hearing that their school work       
suffers severely4 ,most important of    
all1 only a small minority of these     
defects of sight and hearing are        

discovered by teachers or known to them1
 to the parents1 or to the children     
themselves4 ,when the children attempt  
to do their school work while suffering 
from these defects1 among the results   
may be counted permanent injury to the  
eyes1 severe injury to the nervous      
system due to eyestrain1 and depression 
and discouragement1 owing to inability  
to see and hear clearly4  ,moreover1    
there are other defects1 in particular  
those of nose1 throat1 and teeth1 which 
are common among children and which have
 an important bearing upon their present
 health and future development4 ,the    
importance of these defects is          
emphasized by the fact that1 if         
discovered early enough1 they may easily
 be remedied or modified1 whereas       
neglect leads1 almost invariably1 to    
permanent impairment of physical        
condition4 ,these are the reasons why   
,cleveland's heavy investment in school 
dispensaries is yielding a return in    
enhanced health1 happiness1 and vigor   

probably unexcelled by the dividends    
from any other sort of educational      
expenditure4     ,,dental ,,clinics     
,dental work for school children was    
introduced about a year ago by the      
,cleveland ,auxiliary of the ,national  
,mouth ,hygiene ,association4 ,building 
space is provided by the ,board of      
,education in four schools1 ,stanard1   
,lawn1 ,fowler1 and ,marion4 ,the       
,association furnishes equipment1       
dentists1 and assistants4 ,clinics are  
open three forenoons a week and are     
crowded to capacity4  ,illustration3    
,the equipment of the ,marion ,school   
dental clinic cost about #gjj4  ,when   
this work started1 it was frankly an    
experiment4 ,through wise and thoughtful
 management the ,mouth ,hygiene         
,association has shown that dental      
clinics for school children are both    
practical and necessary4 ,this having   
been demonstrated1 the time has come    
when the city should take over their    
direction4 ,cleveland should no longer  

rely upon the activity of a private     
organization1 but at an early date      
should assume full financial and        
administrative responsibility for dental
 clinics in the public schools4  ,dr4   
,william ,osler1 the distinguished      
,english physician1 is credited with    
saying1 ,if ,i were asked to say whether
 more physical deterioration was        
produced by alcohol or by defective     
teeth1 ,i should say unhesitatingly1    
defective teeth4 ,the development of the
 movement for dental inspection of      
school children in ,cleveland shows that
 the educational system has been        
awakening to a realization of the truth 
and significance of ,dr4 ,osler's       
statement4 ,the most salient fact in the
 situation is that the commonest of all 
physical defects among school children  
is decayed teeth4 ,cases of dental      
defectiveness are frequently greater in 
number than are all other sorts of      
physical defects combined4 ,moreover1 it
 is probably true that there is no      

single ailment of school children which 
is directly or indirectly responsible   
for so great an amount of misery1       
disease1 and mental and physical        
handicap4 ,these are reasons why        
,cleveland should steadfastly continue  
in the maintenance and development of   
the dental clinics4     ,,eye ,,clinics 
,an eye clinic is maintained by the     
,department of ,medical ,inspection at  
the ,brownell ,school4 ,this clinic is  
open every afternoon during the school  
year4 ,the method of procedure is as    
follows3 ,during the routine physical   
examinations of children by the doctors 
in the different schools1 the vision is 
tested and1 if found defective1 the     
parents are advised of it by note4 ,the 
nurse then follows up the case and if   
she finds that the parents are unable to
 pay for an examination by an oculist1  
she takes the child to the school       
clinic1 after having obtained the       
written consent of the parent4 ,there   
the child is given a thorough and       

accurate examination1 the eyes being    
first dilated with homatropin and the   
error of refraction determined by means 
of the retinoscope4 ,the proper glasses 
are ordered for the child and in a few  
days he is brought back to the clinic   
and the frames carefully adjusted4 ,the 
nurse then keeps in touch with the case1
 seeing to it that the child wears the  
glasses1 that the frames are straight1  
and that the symptoms of which the child
 complained are relieved4               
,illustration3 ,the eye clinic is       
advertised by its loving friends4  ,many
 parents are unable to pay an oculist's 
fee but are able and willing to pay a   
small amount for glasses and in these   
cases a nominal charge is made for them4
 ,experience has shown that if a charge1
 no matter how small1 is made for the   
glasses better care is taken of them and
 better results are obtained4 ,in some  
cases there has been opposition on the  
part of the parents to the child's      
wearing glasses1 but usually the nurse  

has been able to prove to them the      
necessity and has obtained their        
consent4  ,during the school year       
#aiad-ae1 the total number of dispensary
 visits was #a1iac4 ,in #ffe cases the  
eyes were refracted and in #ejj cases   
glasses were furnished4 ,in about #ge   
per cent of the cases the children's    
symptoms are relieved and their         
scholarship is improved4 ,in about #aj  
per cent of the cases the symptoms are  
not relieved4 ,about five per cent of   
the children refuse to wear the glasses4
 ,the remaining #aj per cent of the     
children cannot be located because they 
have moved from the city or been        
transferred to private schools4 ,the    
value of the work of the eye clinic is  
beyond question4  ,there are no other   
clinics in connection with the          
,cleveland public school system4 ,mental
 examinations are made by a special     
teacher appointed for that purpose4 ,all
 surgical cases are referred to family  
physicians or local hospitals for       

treatment4     ,,co-,,operation ,,of    
,,college ,,for ,,barbers   ,rather an  
unusual form of clinical work is found  
in service rendered by students of the  
,cleveland ,college for ,barbers4 ,in   
several districts an arrangement between
 the school physician and the college   
provides that free hair cuts be         
furnished pupils at intervals during the
 school year4 ,the coming of the barber 
is an event eagerly greeted1 and        
principals report that as a result      
children show increased pride in        
personal appearance4     ,,the ,,medical
 ,,inspection ,,staff   ,the            
organization of the staff deserves      
special comment4 ,the physicians        
employed are mature men1 graduates of   
well-known medical schools4 ,the        
youngest medical inspector on the staff 
is #bi1 the oldest #df1 and the average 
age of all the doctors is #cf4 ,they are
 picked men1 selected for the work      
because of their skill1 intelligence1   
and social viewpoint4 ,they are         

splendidly representative of the medical
 profession in ,cleveland4 ,they have   
fairly wide private practices and in    
many cases are carrying on the school   
work at real financial sacrifice because
 of their interest in the problems it   
involves4 ,their assistants are all     
registered nurses from the ,visiting    
,nurses ,association and distinctly high
 grade women4  ,medical inspectors      
receive #ajj a month during the school  
year4 ,they are required to give three  
and one-half hours a day1 five days a   
week1 to work in the schools1 inclusive 
of traveling time between buildings4    
,nurses are paid on the schedule of the 
,visiting ,nurses ,association and      
salaries range from #fj to #hj depending
 upon length of service4 ,the upper     
limit will probably be raised to #he in 
the near future4 ,nurses are on duty    
from #h3cj to #d3cj every weekday except
 ,saturday1 when work ends at noon4     
,nurses are regularly employed only     
during the school year1 but two are     

retained longer for service in summer   
schools4  ,the efficiency of doctors and
 nurses is in no small measure due to   
the frequent informal conferences of the
 staff4 ,in addition to many smaller    
conferences1 once each month the entire 
staff meets--nurses as well as          
physicians--to discuss problems which   
have arisen during the preceding weeks1 
and makes plans for the future4 ,these  
meetings are very informal2 nurses are  
urged to take part in the discussion1   
and the result is the enthusiastic      
co-operation of the entire staff4       
,,the ,,plan ,,of ,,concentrating       
,,interests   ,an interesting feature of
 organization is the plan whereby each  
year a different series of problems is  
attacked1 and the energies of the entire
 staff directed along this line4 ,thus1 
#aiaj-aiaa shows special emphasis laid  
upon eye defects1 and nearly #aa1jjj    
children were found in need of glasses4 
,in #aiaa-aiab1 although the number of  
defects discovered increased1 the number

 of children examined strikingly        
decreased4 ,extra study was made of     
adenoids1 glands1 nutrition1 and goitre4
 ,the following year less emphasis was  
laid on discovering defects and the     
entire staff united in an effort toward 
correcting those already noted4         
,practically every child in the system  
was examined4 ,at the same time one     
member specialized on hunting for       
tuberculosis cases and another on mental
 examinations of backward children4  ,in
 #aiac-aiad1 the force was especially   
interested in the question of           
communicable disease and the proportion 
of conjunctivitis1 ring worm1 impetigo1 
scabies1 and pediculosis discovered and 
treated was very large4 ,as a natural   
accompaniment of this activity1 the     
number of home visits and school        
treatments decidedly increased4 ,in     
addition1 there was a notable rise in   
the frequency with which parents came to
 the dispensary for conferences with the
 doctor about their children4  ,the     

record for #aiad-aiae shows a decrease  
in the number of home visits1 which is  
partly accounted for by the fact that   
the number of dispensary visits made by 
nurses has practically doubled4 ,the    
number of parent consultations with     
doctors has increased by one-half the   
record for #aiad1 and in contrast with  
#ejj health talks given to classes by   
nurses last year1 we have #a1bfj talks  
by physicians and #d1dca by nurses to   
classes in #aiad-aiae4  ,this method of 
varied problems is unquestionably       
effective in promoting growth and       
maintaining interest on the part of the 
staff4 ,care should be taken1 however1  
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 defects4 ,how this   
emphasis should be distributed is a     
matter best decided by the staff in     
conference4 ,it might be found advisable
 to adopt a plan whereby special        

attention is given to teeth1 adenoids1  
tonsils1 and glands in the lower grades2
 posture and heart in the upper grades2 
and eyes1 hearing1 lungs1 and nutrition 
straight through the grades4 ,whatever  
plan is adopted must be the result of   
study1 consultation1 and experiment1 in 
an endeavor to find the most economical 
investment of effort on the part of     
nurses and doctors in terms of results  
gained4  ,illustration3 ,columns are    
proportionate in height to the per cent 
of physical defects corrected each year 
for five school years4  ,speech defects 
are very common among children4 ,at     
first they yield readily to treatment1  
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 task4     
,judging from the experience of other   
cities1 about #bjj boys and #hjj girls  
in the ,cleveland public school system  
are suffering from some form of speech  
defect4 ,there are few fields in which  

the medical inspection department has   
such an opportunity for effective work  
and in which so little has been done4   
,effort should be made to locate these  
children1 and form them into groups for 
daily training1 under the direction of a
 teacher specially prepared to handle   
speech cases4     ,,uniform ,,procedure 
,in the fall of #aiad1 the medical staff
 conducted a survey of its own          
efficiency4 ,a committee prepared       
questions concerning procedure1 and     
secured answers from each member of the 
staff4 ,these answers were compared and 
discussed in staff meetings and uniform 
rules were finally adopted for          
examinations and recording4  ,in line   
with this1 the staff somewhat earlier   
prepared rules for reporting defects so 
that all records may be compiled on the 
same basis4 ,this standardization of    
work is an especially noteworthy feature
 of the ,cleveland system1 and should   
furnish valuable suggestions to medical 
inspection departments of other cities4 

,a few of the rules adopted by the staff
 will serve to indicate the nature of   
their work3       ,teeth--,report       
decayed first or second teeth1 and      
reddened      and inflamed gums4 ,do not
 report loose first teeth4              
,tonsils--,report cases with histories  
of recurrent      tonsilitis1 and where 
the size of the tonsils causes          
difficulty of swallowing or thick       
speech4 ,do not report      moderately  
enlarged tonsils with no history of     
tonsilitis      nor evidence of         
mechanical obstruction4                 
,adenoids--,report mouth breathers with 
characteristic      adenoid faces1      
convincing yourself as to diagnosis by  
having      the pupil say l1 m1 n1 o1 p4
 ,do not try to confirm the             
diagnosis of adenoids by a digital      
examination of the      nasopharynx4    
,glands--,report general glandular      
enlargement and cervical                
enlargement of the lymphatic glands     
accompanied by      malnutrition and    

anemia4 ,do not report submaxillary     
enlargement in recurrent tonsilitis or  
carious teeth or      post-cervical     
enlargement in pediculosis capitis1 or  
in      impetigo or eczema of the scalp4
  ,as a result of rules such as these1 a
 given report means the same thing to   
every member of the staff2 only         
important defects are stressed2 and the 
effort to remedy them is concentrated   
where it will be most effective4        
,statistics based on records such as    
these will be reliable and may be used  
for scientific study4     ,,vaccination 
,thirteen years ago smallpox visited    
,cleveland4 ,twelve hundred and         
forty-eight cases were reported4 ,there 
were #cj cases of black smallpox4 ,many 
of the patients were blinded or         
disfigured for life2 #bbd died4 ,we find
 in the annual report of the ,board of  
,health for that year3 ,it was the      
smallpox we read about1 that terrible   
scourge which struck terror into the    
former generations4 ,its contagious     

nature showed itself everywhere4 ,one   
case1 if not promptly reported to the   
health office and removed to the        
hospital1 would invariably infect the   
whole neighborhood4 ,its severity       
manifested itself even in the milder    
cases1 while confluent cases1 almost    
without exception1 developed hemorrhages
 during the pustular state4444 ,at the  
,mayor's request1 a meeting of          
physicians was held 444 to consider the 
smallpox situation4444 ,vaccination was 
recommended on all sides1 but the people
 were not prone to get vaccinated4444   
,wholesale vaccination was finally      
effected by the action of the ,school   
,council and the help of the ,chamber of
 ,commerce4 ,the ,school ,council       
amended the vaccination clause1 making  
vaccination a conditio sine qua non for 
attending school and giving the health  
officer the whole control of the matter4
 ,without this amendment the schools    
could not have opened last fall4 ,the   
situation was too critical4 ,with it1   

the opening of the schools helped       
greatly to exterminate smallpox4 ,every 
school1 public and private1 was put in  
the charge of a physician4444 ,the      
doctors worked with a will1 and if      
anything was done thoroughly and        
conscientiously in this city1 it was the
 vaccination of all teachers and pupils 
last fall4444 ,through the influence of 
the ,chamber of ,commerce the employers 
prevailed on their employees to get     
vaccinated4 ,also to have everyone of   
their family vaccinated4 ,the           
consequence was that the people got     
vaccinated by tens of thousands4 ,men   
who formerly spurned the vaccinator from
 their door came now to his office4444  
,the city paid for #aie1jjj             
vaccinations4  ,in #aiaj smallpox again 
broke out1 this time in the southeastern
 part of the city1 and threatened to    
spread over the entire community4 ,with 
vivid memories of earlier horrors1 the  
disease was met at the outset with      
vigorous measures4 ,it was discovered   

that in spite of the experience of the  
,board of ,education eight years before1
 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 smallpox1      
unvaccinated children had been admitted 
to the public schools literally by      
thousands4 ,by the time that #fc cases  
of smallpox had been reported the ,board
 of ,health again took matters into its 
own hands1 entered the schools1 and     
vaccinated #ee1jjj school children4     
,equally vigorous measures were taken   
among adults and the epidemic was       
checked4  ,every year since #aiaj there 
have been cases of smallpox in          
,cleveland4 ,the ,board of ,health no   
longer relies upon the ,board of        
,education to protect the lives of the  
community against the scourge4 ,where   
#gj1jjj children are gathered together  
daily for hours at a stretch1 the       

possibilities of spreading disease      
throughout the city at large constitute 
a grave menace4 ,therefore1 immediately 
upon the report of a case of smallpox1  
the ,board of ,health officials exercise
 their right of entry into the schools  
of that district1 and either vaccinate  
or exclude from attendance every child  
who could himself become a carrier of   
the disease4 ,during the present year   
over #a1djj children were vaccinated in 
this way4  ,that vaccination prevents   
smallpox no intelligent person          
acquainted with the facts can doubt4 ,an
 overwhelming mass of incontrovertible  
evidence can be found in every medical  
library4 ,the mortality statistics of   
different countries tell the same story4
 ,a single example shows the general    
experience3 ,in seven provinces of the  
,philippine ,islands there were #f1jjj  
deaths annually from smallpox alone4 ,in
 his #aijf report1 ,dr4 ,victor ,g4     
,heiser1 ,director of ,health in the    
,islands1 describes how drastic measures

 were taken to stamp out the disease4   
,under his direction practically three  
million one hundred thousand persons    
were vaccinated4 ,the following year1   
instead of #f1jjj deaths from smallpox1 
there was not one4  ,for #ac years the  
,board of ,education has had upon its   
books a rule requiring vaccination as a 
prerequisite to admission to the        
schools4 ,that rule has never been      
adequately enforced4 ,in ,july1 #aiad1  
,city ,ordinance #cbhdf-;,b was passed1 
one section of which reads3 ,no         
superintendent1 principal1 or teacher of
 any public1 parochial1 private school1 
or other institution1 nor any parent1   
guardian1 or other person1 shall permit 
any child not having been successfully  
vaccinated1 nor having had smallpox1 to 
attend school4 ,although passed a year  
ago1 that ordinance has not yet been    
enforced4 ,exact figures cannot be      
secured1 but it is probable that there  
are in the ,cleveland schools today more
 than #ej1jjj unvaccinated children4    

,for each of these the superintendent1  
principal1 teacher1 and parent may be   
held liable to a #bjj fine1 #fj days    
imprisonment1 or both4     ,,future     
,,development   ,compared with other    
large cities1 ,cleveland has an         
unusually good system of medical        
inspection4 ,where other cities are     
still struggling with details of        
organization1 record keeping1 and the   
like1 ,cleveland is ready to lead the   
way into new and immensely important    
fields4  ,medical inspection includes   
four fields of endeavor3 prevention of  
epidemics1 discovery and cure of        
physical defects1 provision of healthful
 surroundings1 and formation of correct 
habits of thought and action in regard  
to health4 ,the first two are concerned 
with remedying present conditions1 and  
here ,cleveland is doing excellent work4
 ,the latter two provide health         
insurance for the future4 ,in these1    
,cleveland has made a beginning but     
should carry her efforts far in advance 

of anything now attempted4  ,thirteen   
years ago a crusade was started against 
the common drinking cup4 ,today there is
 not a school in the city which is not  
supplied with sanitary drinking         
fountains1 and the common cup is a thing
 of the past4 ,nine years ago individual
 towels were supplied to children in    
certain schools4 ,at the present time   
individual towels1 soap1 and hot water  
are available in every building4 ,in    
#aijf the first shower bath was         
installed in an elementary school4 ,now 
there are #cg buildings so equipped4    
,the windows in some of the classes for 
the blind are made of amber tinted      
glass4 ,for years there has been        
agitation in favor of adjustable seats  
and desks1 and although conditions in   
certain schools are still very bad1     
these are exceptions1 and the general   
seating provision is in accordance with 
the laws of hygiene4  ,illustration3    
,shower baths installed in an old       
building in a crowded section4  ,but the

 ,division of ,medical ,inspection must 
go farther than this4 ,the physician    
must join with the psychologist and the 
educator in scientific research to      
determine the conditions best suited to 
the education of the child4 ,shall      
blackboards be of slate1 composition    
board1 or glass8 ,shall they be colored 
black1 green1 or ivory white8 ,is light 
chalk on a dark ground better or worse  
than dark chalk on a light ground8 ,is  
prismatic window glass superior to      
plain8 ,to what extent is glare from    
polished desks detrimental to eyesight8 
,how large must be the type in textbooks
 in order that young children may easily
 read it8 ,what variations from the     
present school program are necessary in 
order to make adequate provision for    
change in the use of different sets of  
muscles1 and relief from nerve strain8  
,these questions and hundreds of others 
are facing educational authorities4 ,the
 method of answering them affects not   
only the children of one city but the   

children of all cities throughout the   
country4 ,everywhere schoolmen are on   
the alert to gain information which will
 help in solving these problems4  ,in   
addition to regular work of inspection  
and examination1 the doctors and nurses 
of ,cleveland spend a great deal of time
 in conferences with parents1 talks with
 teachers1 lessons and talks to         
children1 toothbrush drills1 and the    
like4 ,the importance of work of this   
kind can hardly be overestimated1 but it
 must be far more than talks at people4 
,it should be the aim of the ,department
 of ,medical ,inspection to establish   
right habits in regard to health4 ,for  
this reason1 although both methods are  
helpful1 drill in the use of the        
toothbrush is more effective than       
lectures on the need of using it4 ,as a 
result of the work of doctors and       
nurses1 ,cleveland's children1--and her 
teachers as well1--should not only      
believe in plenty of sleep1 but should  
go to bed early2 not only disapprove of 

too much tea and coffee1 but have       
strength to refuse when it is offered4  
,through classes for the anemic and     
pre-tubercular1 the public schools help 
each year between two and three hundred 
children4 ,this is worth doing1 but they
 will render a far greater service to   
,cleveland if1 in addition1 they succeed
 in giving to #hj1jjj children1 so      
firmly that it will never be broken1 the
 habit of sleeping winter and summer    
with wide open windows4  ,the dentist1  
the oculist1 the physician1 should come 
to be regarded1 not as dispensers of    
cures nor sympathetic listeners to      
hypochondriacs1 but as leaders to whom  
intelligent people go in order to       
forestall trouble1--specialists in      
health rather than disease4 ,leading its
 future citizens to form right habits of
 thinking and acting in regard to health
 is one of the greatest educational     
services which the public school can    
render4     ,,ten ,,types ,,of ,,health 
,,work   ,as the work in ,cleveland     

develops1 it should aim to include all  
those types of activity which extended  
and varied experience has shown to      
better the health of school children1   
safeguard them from disease1 and render 
them healthier1 happier1 and more       
vigorous4 ,among such activities the    
following are of special importance3    
#a4 ,medical inspection for preventing  
the spread of contagious disease and for
 the discovery and cure of remediable   
physical defects4  #b4 ,dental          
inspection for the purpose of securing  
sound teeth among these school children4
  #c4 ,the steady development of the    
work of the school nurses to the end    
that their co-operation with doctors1   
teachers1 and parents may progressively 
contribute toward improving the health  
of the children4  #d4 ,open-air schools 
for giving to the physically weak such  
advantages of pure air1 good food1 and  
warm sunshine as may enable them to     
pursue their studies while regaining    
their physical vigor4  #e4 ,special     

classes and schools for the physically  
handicapped and mentally exceptional in 
which children may receive the care and 
instruction fitted to their needs4  #f4 
,school gardens1 which serve as nature  
study laboratories1 where education and 
recreation go hand in hand1 and         
increased knowledge is accompanied by   
increased bodily efficiency4  #g4       
,school playgrounds1 which afford space1
 facilities1 opportunity1 and incentive 
for the expression of play instincts and
 impulses4  #h4 ,organized athletics1   
which aid in physical development1 and  
afford training in alertness1 intense   
application1 vigorous exertion1 loyalty1
 obedience to law and order1            
self-control1 self-sacrifice1 and       
respect for the rights of others4  #i4  
,systematic instruction and practice in 
personal and community hygiene and      
sanitation4  #aj4 ,the progressive      
improvement of all adjuncts of better   
sanitation in school houses1 such as    
sanitary drinking cups and fountains1   

systems of vacuum cleaning1 improved    
systems of lighting1 heating1 and       
ventilation4     ,,health ,,and         
,,education ,,and ,,business   ,there is
 one condition in the ,cleveland school 
system which rises like a mighty barrier
 against the possibility of completely  
fulfilling any such program of health   
education as that outlined in the #aj   
planks of the preceding platform4 ,this 
is the fundamental fact that the        
,cleveland school authorities have not  
yet conceived of health work as being an
 integral part of education4  ,in this  
city the work of the ,board of          
,education is divided into three main   
departments4 ,these are the executive   
department1 the educational department1 
and the department of the clerk4 ,the   
executive department is under the       
leadership of the director of schools   
and it deals with the business          
activities of the ,board4 ,the          
educational department is under the     
superintendent of schools and deals with

 teaching4  ,under this organization the
 activities carried on by the ,board of 
,education must be assigned to one or   
another of the departments and this     
entails in most cases arriving at a     
decision as to whether the work in      
question is predominantly of an         
educational nature or of a business     
nature4 ,in dealing with health work in 
the public schools1 the ,board of       
,education rendered its decision both   
ways4 ,it decided that provision for    
health in education was a series of     
business transactions and so it placed  
medical inspection in the executive     
department under the leadership of the  
director4 ,it also decided that         
provision for education in health was a 
teaching problem and so it placed       
physical education and training in      
physiology and hygiene under the        
direction of the superintendent of      
schools4  ,despite its decision that    
provision for health in education is a  
business matter1 while provision for    

education in health is a teaching       
matter1 the ,board realized that some   
sort of unity was essential if the      
different sides of the work were carried
 forward efficiently4 ,they met this    
situation by employing a competent      
director of health work and giving him  
an official dual personality4 ,as the   
official held responsible for health in 
education1 he is the director of medical
 inspection and is subordinate to the   
director of schools4 ,as the official   
responsible for education in health1 he 
is an assistant superintendent and is   
responsible to the superintendent of    
schools4 ,in one capacity he is         
appointed by the superintendent and     
receives a portion of his salary from   
educational funds4 ,in his other        
capacity he is appointed by the director
 of schools and paid from business      
appropriations4 ,as an employee of the  
educational department1 he is appointed 
for a term of one year1 but as an       
employee of the business department1 he 

is on the civil service list with an    
indeterminate period of employment4  ,in
 his educational capacity1 he may       
arrange for the organization of         
basketball teams for this is held to be 
a matter of physical education1 but in  
order to have a basketball game actually
 played at any time outside of regular  
school hours1 he must get the permission
 of the director1 for this is held to be
 a business transaction4  ,instruction  
in infant hygiene is given to the girls 
in the upper grades4 ,part of the       
teaching is done by the regular         
teachers1 the rest by the nurses of the 
medical inspection department4 ,when the
 instruction is given by the teachers1  
it is considered an educational activity
 and is under the supervision of the    
superintendent2 when the same class is  
taught by the nurse1 it is considered a 
business transaction and is under the   
authority of the director4  ,as chief   
medical inspector1 representing the     
business department1 this official      

discovers a feeble-minded child whom he 
wishes to transfer to a special class4  
,since the transfer of this child is an 
educational problem1 he reports the     
matter to the assistant superintendent  
in charge of the district4 ,since the   
medical inspector is also an assistant  
superintendent1 these two men are       
co-ordinate educational officials4 ,the 
assistant superintendent of the district
 reports the requested transfer to the  
city superintendent who deals with the  
matter as an educational problem and    
issues an order to the chief medical    
inspector in his capacity as assistant  
superintendent in charge of physical    
education to make the transfer4  ,this  
whole situation1 which arises from      
assigning some phases of the health work
 to the business department and other   
phases to the educational department1   
has not given rise to as many or as     
serious difficulties as might well be   
expected4 ,this relative freedom from   
trouble and friction is an impressive   

tribute to the unremitting tactfulness  
of the officials most directly          
concerned4 ,the chief medical inspector 
is a conspicuous example of a man       
defying holy writ by successfully       
serving two masters4  ,health work in   
,cleveland public schools is on a higher
 plane than in most other cities4 ,its  
present accomplishments have carried it 
further than similar work has gone      
elsewhere4 ,its future possibilities are
 unusually bright because the early     
stages of development have been         
successfully passed4 ,the one thing that
 we may be sure of is that this future  
development will tend toward an ever    
closer relationship and more intimate   
intermingling of the activities which   
make for health in education and those  
which are directed toward education in  
health4 ,each new development and each  
forward step renders a separation of the
 work into educational and business     
activities progressively difficult4  ,to
 discover decayed teeth and to teach    

children to care for their teeth are    
intimately related matters and their    
separation is bound to be theoretical   
and not real4 ,to attempt to separate   
the testing of vision from teaching     
concerning the conservation of vision is
 to lose an opportunity for the most    
effective sort of instruction4          
,similarly1 if one scrutinizes all of   
the #aj items that have been suggested  
as indicating the health activities     
which ,cleveland should continue to     
develop in its public schools1 he can   
hardly fail to appreciate the utter     
impossibility of successfully dividing  
the work into certain activities which  
shall be educational and certain other  
activities which shall be business4     
,sooner or later the theory that this   
can be done will be destroyed by the    
logic of events1 for health work in our 
public schools is constantly becoming a 
more intimate and integral part of the  
every-day education of all the children4
  ,sooner or later serious difficulties 

are bound to arise from an              
administratively unsound arrangement in 
which a school official in charge of a  
most important division of work is      
responsible to two entirely independent 
chiefs4 ,the opportunities for honest   
but irreconcilable conflict of views are
 so numerous that they will surely arise
 in time4 ,one chief may favor          
vaccination and the other be opposed to 
it on principle4 ,one may deem it the   
duty of the schools to have the doctors 
and nurses give instruction in sex      
hygiene while the other may be utterly  
against anything of the sort4 ,one may  
hold that the only useful physical      
exercise is that gained through games   
and athletics1 while the other may favor
 formal gymnastics4 ,one may believe in 
school gardens1 and the other deem them 
a waste of time and money4 ,one may     
believe that courses in infant hygiene  
should be provided for the girls in the 
upper grammar grades1 while the other   
may hold that such instruction should be

 reserved for continuation classes for  
young women4  ,all of these are matters 
on which educational authorities are    
sharply divided in opinion and there are
 many more of the same nature4 ,the     
present director of schools1 the present
 superintendent of schools1 and the     
present chief medical inspector have so 
far worked successfully under the       
present arrangement of divided duties   
and responsibilities1 but a             
reorganization along sounder            
administrative lines should be made     
before1 instead of after1 serious       
trouble arises4 ,eventually1 if not now1
 ,cleveland must realize that health    
work in education must be placed under  
the direction of the city's highest     
educational official who is the city    
superintendent of schools4     ,,summary
   #a4 ,cleveland employs #af school    
physicians1 one oculist1 and #bg nurses4
 ,it spends #cf1jjj a year on salaries  
and supplies for these people1 and      
maintains #hf school dispensaries and   

clinics4  #b4 ,through medical          
inspection1 the educator and the        
physician join hands to insure for each 
child such conditions of health and     
vitality as will best enable him to take
 full advantage of the free education   
offered by the state4 ,it recognizes the
 intimate relationship between the      
physical and mental conditions of       
children4 ,it realizes that education is
 dependent upon health4 ,it betters     
health conditions among school children1
 safeguards them from disease1 and      
renders them healthier1 happier1 and    
more vigorous4  #c4 ,the first work of  
this kind in ,cleveland started in #aijj
 when tests were made of defective      
vision4 ,in #aijf the ,health           
,department provided inspectors for     
contagious diseases in the schools4 ,in 
the same year inspection for physical   
defects was undertaken2 the first       
dispensary in the ,united ,states was   
established at the ,murray ,hill        
,school1 and school nurses were         

appointed4 ,in #aiji the ,division of   
,health ,supervision and ,inspection    
became part of the regular school       
system4  #d4 ,the ,division handles     
inspection for contagious disease1      
inspection for physical and mental      
defects1 follow-up work for the         
remedying of defects1 health            
instruction1 recommendations of children
 to special classes1 school lunches1    
gardens1 and playgrounds4 ,every child  
is examined every year4  #e4 ,cleveland 
has #hf dispensaries4 ,in every case    
lighting1 ventilation1 and equipment are
 good4 ,it is probably true that these  
dispensaries are of better grade than   
those of any other large city in the    
,united ,states4  #f4 ,dental clinics   
are now conducted in four public schools
 by the ,cleveland ,auxiliary of the    
,national ,mouth ,hygiene ,association4 
,this work has now reached a point where
 it should be taken over and            
administered as a part of the public    
school system4 ,the function of a       

private organization is to experiment   
and demonstrate4 ,it cannot eventuate on
 a large scale1 and it should not if it 
could4 ,the function of a public        
organization is to eventuate on a large 
scale4 ,it can seldom experiment1 and it
 lacks freedom and flexibility in       
demonstration4 ,the ,mouth ,hygiene     
,association has experimented and       
demonstrated successfully4 ,its work    
should now be assumed1 continued1 and   
extended by the ,division of ,medical   
,inspection4  #g4 ,the eye clinic       
conducted by the ,division at the       
,brownell ,school is doing excellent    
work4 ,as the system grows1 this clinic 
should be supplied with more workers4   
,the ,cleveland ,college for ,barbers   
gives an excellent free service in many 
of the schools4 ,there are no other     
clinics4 ,mental examinations are made  
by a special teacher appointed for that 
purpose4 ,all surgical cases are        
referred to family physicians or local  
hospitals for treatment4  #h4 ,medical  

inspectors are mature men1 graduates of 
well-known medical schools1 with a      
fairly wide private practice4 ,the      
school nurses are all registered nurses4
  #i4 ,the number of school nurses      
should be increased as rapidly as       
possible until one nurse is provided on 
full time for every #bjjj children      
enrolled in school4 ,this would mean the
 employment of #aa additional nurses1   
increasing the staff from #bg to #cd4   
,as the population increases1 more      
nurses should be added4  #aj4 ,office   
consultations between parents and       
physicians are among the most important 
activities of the ,division and should  
be systematically encouraged4 ,to this  
end arrangements should be made whereby 
definite hours for parent consultations 
are assigned to each school4  #aa4 ,the 
,division of ,medical ,inspection has so
 organized its work that the attention  
of the staff is concentrated upon a     
different set of problems each year4    
,this method is unquestionably effective

 in promoting growth and maintaining the
 interest of the staff4 ,care should be 
taken1 however1 to provide that within  
each four-year period special emphasis  
be laid upon the discovery and cure of  
each of the more important defects4     
,some plan should be adopted by the     
staff whereby effort may be concentrated
 on discovering and remedying defects at
 those ages where such expenditure of   
time and energy will secure the largest 
returns4  #ab4 ,adequate provision      
should be made for the correction of    
speech defects4 ,classes in speech      
training should be established under the
 direction of a teacher specially       
trained in this work4  #ac4             
,standardization of work is an          
especially noteworthy feature of the    
,cleveland system1 and should furnish   
valuable suggestions to medical         
inspection departments of other cities4 
,through this standardization the same  
terms have uniform meanings when used by
 different members of the staff1 and    

constant standards are employed in      
detecting and recording defects4  #ad4  
,there are probably more than #ej1jjj   
unvaccinated children now in the        
,cleveland schools4 ,immediate steps    
should be taken to see to it that every 
child now in school is vaccinated1 and  
that no child is admitted to school     
hereafter without similar protection4   
,principals1 teachers1 and parents      
should be held responsible for violation
 of the vaccination ordinance4  #ae4    
,the ,division of ,medical ,inspection  
should plan steadily to enlarge its     
field of activity in order to provide in
 constantly increasing measure better   
working conditions in the schools and to
 train the children into habits of      
health that shall be life-long4 ,it is  
probable that the health work in the    
,cleveland public schools is unsurpassed
 by that of any other city in the       
country4 ,the city now has an           
opportunity to lead the way into vastly 
important forward extensions looking    

toward the provision of health insurance
 for future generations4  #af4 ,under   
the present organization1 the official  
in charge of health work is responsible 
to the director of schools in part of   
his activities and to the superintendent
 in the rest of them4 ,he should be     
responsible to the city superintendent  
alone1 for health work in the public    
schools is education and not business4  
,,cleveland ,,education ,,survey        
,,sectional ,,reports   ,these reports  
can be secured from the ,survey         
,committee of the ,cleveland            
,foundation1 ,cleveland1 ,ohio4 ,they   
will be sent postpaid for #be cents per 
volume with the exception of ,measuring 
the ,work of the ,public ,schools by    
,judd1 ,the ,cleveland ,school ,survey  
by ,ayres1 and ,wage ,earning and       
,education by ,lutz4 ,these three       
volumes will be sent for #ej cents each4
 ,all of these reports may be secured at
 the same rates from the ,division of   
,education of the ,russell ,sage        

,foundation1 ,new ,york ,city4    ,child
 ,accounting in the ,public             
,schools--,ayres4   ,educational        
,extension--,perry4   ,education through
 ,recreation--,johnson4   ,financing the
 ,public ,schools--,clark4   ,health    
,work in the ,public ,schools--,ayres4  
,household ,arts and ,school            
,lunches--,boughton4   ,measuring the   
,work of the ,public ,schools--,judd4   
,overcrowded ,schools and the ,platoon  
,plan--,hartwell4   ,school ,buildings  
and ,equipment--,ayres4   ,schools and  
,classes for ,exceptional               
,children--,mitchell4   ,school         
,organization and                       
,administration--,ayres4   ,the ,public 
,library and the ,public ,schools4      
,the ,school and the ,immigrant4   ,the 
,teaching ,staff--,jessup4   ,what the  
,schools ,teach and ,might              
,teach--,bobbitt4   ,the ,cleveland     
,school ,survey 7,summary               
volume7--,ayres4         99       99    
99       99       99    ,boys and ,girls

 in ,commercial ,work--,stevens4        
,department ,store                      
,occupations--,o',leary4   ,dressmaking 
and ,millinery--,bryner4   ,railroad and
 ,street ,transportation--,fleming4     
,the ,building ,trades--,shaw4   ,the   
,garment ,trades--,bryner4   ,the ,metal
 ,trades--,lutz4   ,the ,printing       
,trades--,shaw4   ,wage ,earning and    
,education 7,summary volume7--,lutz4    
,transcriber's ,note3  ,the following   
type-written material was attached      
inside the front cover of this book and 
is included here for its historical     
interest4                ,,division ,,of
 ,,medical ,,inspection                 
and                     ,,physical      
,,education                             
,,cleveland     ,dr4 ,e4 ,a4 ,peterson  
,director    ,mr4 ,h4 ,p4 ,kimmel       
,secretary    ,henry ,w4 ,luther        
,supervisor of ,physical ,training      
,louise ,klein ,miller                  
,curator of ,school ,gardens    ,anna   
,l4 ,stanley                            

,supervisor of ,school ,nurses          
,charlotte ,steinbach                   
,examiner of ,atypical ,children        
,lola ,barnard               ,ass't4    
,mabel ,j4 ,winsworth                   
,supervisor of ,school ,feeding         
,hannah ,spero                          
,stenographer     ,,the ,,cleveland     
,,foundation ,,survey ,,room #be4 #fab  
,,st4 ,,clair ,,ave1 ,n4 ,e4            
,,cleveland1 ,,ohio  ,november #ah1     
#aiae4  ,the next meeting of the        
,advisory ,committee of the ,education  
,survey will be in the ,assembly ,room  
of ,the ,hollenden1 ,monday1 ,nov4      
#bbnd1 #aiae at #ab4 ,the section of the
 ,survey to be considered will describe 
a feature of school work in which       
,cleveland equals any and excells most  
cities of the country4    ,subject3     
,,health ,,work ,,in ,,the ,,public     
,,schools   ,speaker3 ,,leonard ,p4     
,,ayres1            ,director ,education
 ,survey4  ,you are invited to bring any
 interested friends and are urged to be 

prompt so as to give full time for both 
the luncheon and the discussion4        
,please reply on enclosed card4  ,yours 
truly1 ,f4 ,f4 ,prentiss1 ,chairman4    
,allen ,t4 ,burns1 ,director4  ,end of  
,transcriber's ,note