School doctor

“ In every progressive State, school doctors have now been appointed. It is a sound principle that the school doctor should not be engaged in private practice, but that he should [203] also be physician to the poor-law authority. The institution of the school physician is, however, of value only if a skilled and detailed examination of the individual children is undertaken, and if steps are taken to secure that the medical advice given in individual cases is actually carried out. ”

“ Teachers have simply found physical defects an impediment to the pupil's school progress and desire their removal. The school doctor spends some three to six minutes in the examination of each pupil, looking only for the gross and external symptoms of defectiveness. Having strictly the point of view of the physician, his search is for disease. His training has not fitted him to scent out delicate, incipient deviations from the normal nor to see the necessity of doing so. He does not have a biological conception of the functions of child hygiene. ”

“ They are reasonable—only they do not take account of all the facts. The only persons who could answer John Bull in an altogether illuminating way are the ablest of our own school doctors. And it is unlikely, for various reasons, that they will undertake this task. This is why the mere looker-on has to attempt it.
It is of course necessary to have trained medical men to undertake the work of giving advice in (and treatment later probably through) the schools. ”

“ THE British school doctor exists, but so small is the number of men appointed to this post (they hardly number as yet fifty) , and so greatly do the amount and nature of their work vary, that at present the phrase "school doctor" has no very clear meaning to many. Moreover, a great many people think that even if school children are examined, there need be no school doctor—that a medical officer of health will do quite well for this kind of work. It is clear that the British school doctor is hardly even a new arrival. He is a person who is being quarrelled over on the doorstep! ”

“ No trained nurse, no devoted mother, no clever teacher, no person in authority, can take the place of, or do the specific work of, a trained medical man or woman. And this special training is of course expensive, and those who receive it and give their services afterwards have, of course, a right to be paid at a reasonable rate.
But what does the phrase "a fully qualified school doctor" mean? Where are these "fully qualified" men to be found? The ablest and oldest school doctors know very well that they are not qualified—that they are only apprentices. ”

“ For the better protection of the health of children attending the public schools, school doctors have been engaged to undertake the medical inspection of children on entering school, to be responsible for their health as long as they attend the school, and responsible too for the building itself from the point of view of the scholars' health. ”

“ And it is opportunity, not a bait, that is wanted to bring them into the field. Opportunity would be found for all, if, all over the land, education committees engaged medical men and women to take up it might be only a very small part of the whole duties of a school doctor. They might be engaged for example to visit a school twice or three times a year, and to report on the new scholars or on the sickly or abnormal children. They might, or might not, according to the desire of parents, be permitted to give treatment. ”

“ He looks into various parts of the building, and notes the lighting, warming and ventilation, and sanitation. It may be well to quote part of the Minute in the Wiesbaden scheme in which his duties are indicated.
"Every fourteen days the school doctor will hold a School Consultation at an hour fixed by doctor and head teacher. A certain room is to be placed at his service. ... The first half of the hour will serve for a visit of from 10 to 15 minutes to be paid to from two to five Classes, during the time when the scholars are being taught. ”

“ For about 1871 anyone who wished might enter an American medical school practically anywhere in the country, without any preliminary education, and having taken two terms of ungraded lectures, that is, having listened to the same set of lectures two years in succession, might receive his degree of doctor of medicine. ”

“ Even the school doctor of Germany, moving about in schools every day, must have become conscious of all this. He too has become conscious of great events taking place as a result of the teaching given in the schools. ”

“ The doctor not only watches the general health of the school, but he registers the height, weight, carriage, state of nourishment, and vaccination marks of each child on admission; the condition of the eyes and ears and any marked constitutional tendency he can discover. Every child is examined once a month, when necessary once a fortnight. ”

“ But would not the experts have done better work had they been engaged as co-operators with teachers and parents twenty years ago, and long before any crime was committed? Truly the rich, as well as the poor, have some reason to desire the advent of the school doctor.
"But they can engage him," some may cry, "to work in a very exclusive way in the exclusive school!" No, that is impossible. There is, as we have said already, no training college here, or even in Germany, for school doctors! ”

“ In the great industrial centres the school doctor's advice was very often flung away. We know now that more than half of all the children are in such a condition that advice should be given about them to their parents! But in the poorer schools only 3 per cent of the children needing spectacles get them. Of the 30 per cent of all the children who have adenoids, of the 8 per cent even who have this distressing ailment in a very acute form, the school doctor may have inspected a great number; but how many even of these have received treatment? ”

“ If the expert medical officer begins this work, he certainly cannot begin it as an expert. He may learn rapidly, but still he is a beginner. This will mean that he makes a sacrifice.
One does not begin, as one of the youngest apprentices, by receiving a large salary.
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The popular way of looking for the good school doctor is to offer him a large salary. And yet it does not work out very well. "If there is one thing I hate," said a certain medico the other day, "it is this school hygiene, and all this child-study that people are going in for now. It's all nonsense. ”

“ There are some who frankly admit that their entrance into Medical School was due solely to the influence of parents and relatives, and that their present vital interest in what they are doing dates back not to any childhood desire for the doctor's profession, but only to the stimulating experiences of the school itself. ”

“ And so the Doctor, at the beginning of the next half-year, looked out the best of the new boys, and separated you and East, and put the young boy into your study, in the hope that when you had somebody to lean on you, you would begin to stand a little steadier yourself, and get manliness and thoughtfulness. And I can assure you he has watched the experiment ever since with great satisfaction. Ah! not one of you boys will ever know the anxiety you have given him, or the care with which he has watched over every step in your school lives. ”

“ Nearly every German writer on the subject turns aside to emphasise the importance of it—to show that here is one of the greatest opportunities that can ever be enjoyed by any citizen. "The education authorities of many cities have the desire to reach the parents," says Schubart. "They find a great and new opportunity in meeting them. A school doctor who sees the real scope of his work appreciates this fact." It seems that nearly all are eager to speak to the parents at the examination. ”

“ To begin with, there is no standard of comparison between children to-day who have gone through the eight years of school life and children of the same age in 1896, when school doctor's work was fairly started. And then it is well known that through the eight years of elementary school life—say from six to fourteen—children do grow out of certain weaknesses, and the life risks are getting less. ”

“ In the Hungarian Minute of twenty years ago it is set forth that "in the examination of new scholars, held at the beginning of every year, the doctor shall satisfy himself as to the health and condition of all children, more especially giving attention to the heart and lungs, and make known to the teachers whether children can take the usual physical exercises or drill, singing, etc. ”

“ It is well known that these cases are often tedious, and parents cannot spare the time to go often to hospital. A large number cannot, or do not even go once after being warned. "He will grow out of it," they say of the sufferer. So the case is neglected, and the patient becomes in many cases deaf for life. Well, the school doctor cannot at present do anything—it is his business to note the evil, and then to leave everything to take its course—and hurry on to the next school. ”

“ It is quite certain that in the organisation and the practical working of the special schools the doctor has a rôle, and an important rôle, to fill. All foreign countries recognise this, and give him a large place. It is even regretted in some countries that doctors detach themselves too much from such questions, and are content to make a rapid and superficial examination of children on their entrance to school, instead of collaborating actively in the important work of the teacher. ”

“ Doctors obtain an enormous sense of self-importance at medical school, where they proudly endured the high pressure weeding out of any free spirit unwilling to grind away into the night for seven or more years. ”

“ But as a matter of fact work in the schools, and the experience gained thus by doctors who have taken the ordinary diplomas, and whose attention is turned to scholastic problems, is the only means of getting an all-round training in England to-day. ”

“ We have already seen how from 10 to 20 per cent of all children go to these for a shorter or longer time; and how, at Mannheim, many are more than ready after a time to go back to the ordinary school. This kind of "result" is being welcomed all the time by doctor, teacher, and parent, and it is altogether the result of training that is largely treatment. For in such schools the doctor is in a sense the head master, inasmuch as he is responsible for the order of the teaching, and all the details of the work, in a very special way. ”

“ In most of the large towns the scholar from first to last receives free systematic medical care at the hands of the school doctors. It begins with a thorough examination on admission, and the health record thus opened is continued throughout the whole period of school life, so that the child is under constant medical supervision until it reaches the working age. Many towns have gone further, and have established dental surgeries, and attached eye and ear specialists to the primary schools. ”

“ However, it appears certain that even the examination of a diseased child does not take long. It is the examination that follows on treatment, not the first general examination, that requires time and patience.
After the first examination each child gets a health card, which the teacher keeps. There are three orders of card— "Good," "Fair," and "Bad." The first card is that of the healthy children—the "good "group. In the second are the children in "fair" health. In the third or "bad" group are the children who suffer from some disease, or who are very weakly. ”

“ Rhythmic Drills Teachers should never send children to a doctor without the consent of their parents. A teacher’s help can be rendered in instituting preventive measures better than in administering or advising curative remedies. The harm done to the teeth by allowing them to decay through the use of improper food, also the proper use of the tooth brush, and the value of a sterilizing mouth wash can easily be taught and come within the teacher’s legitimate province. In many towns she may also secure the coöperation of the school nurse. ”

“ Teaching in matters pertaining to health is assigned little time in the elementary schools, and the time that is assigned to it is frequently given to something else. The subject gets pushed off the program by one of the so-called "essentials." A course in hygiene should be drawn up, and practical applications of the work should be arranged through having pupils look after the sanitary conditions of rooms and grounds. The school doctors and nurses should help in this teaching and practice. ”

“ The main task of the medical schools will always be to train physicians. It does not fall within the scope of this address to define what this training should be, and I shall not attempt it, excepting in so far as it bears upon laboratory instruction. I believe that the medical school should make the future physician absorb as much as possible of the best medical science of the day and give him a certain initial skill and dexterity in carrying out the fundamental operations of the medical art. ”

“ Some young men are sent to learn to be Physicians, who have had some learning, and others are sent directly from the plough, who can scarcely read, or even write their own Names, and thus the Doctor becomes furnished with Pupils. ”

“ Only they must not be disappointed if they find many subjects treated in our courses as a medical class requires, rather than as a scientific class would expect, that is, with special limitations and constant reference to practical ends. Fortunately they are within easy reach of the highest scientific instruction. The business of a school like this is to make useful working physicians, and to succeed in this it is almost as important not to overcrowd the mind of the pupil with merely curious knowledge as it is to store it with useful information. ”