CHAPTER XIX.

MEDICAL INSPECTION OF SCHOOLS.

The movement for the medical inspection of school children hardly antedates the beginning of the present century. Like all such movements it has manifested itself in several distinct phases.

There is the period of argument. In this country the health authorities took the initiative. They argued that since contagious diseases are disseminated in crowded assemblies, the school should be inspected regularly in order to exclude children afflicted with contagious diseases.

This was the earliest argument used in favor of medical inspection, and it was a health measure in the interest rather of the public than of the individual. Epidemics in a community paralyze all commercial enterprises.

Later the scope of the argument for inspection was supplemented by the school authorities who found that many children in the public schools were physically handicapped in their studies; and as the state assumed the responsibility to train the children mentally, it was not unreasonable to assume that the state should safeguard the children against unfavorable physical conditions.

This period of argument was followed by a period of trial, through which we have passed. As a result we find that several states have passed mandatory laws compelling the local school authorities to make provision for doing this work, and hundreds of cities are

gradually building up medical inspection systems. This will mean that during the coming twenty-five years a very large force of properly trained men and women will be required for this kind of work in this country. The nature and scope of the work will be understood from these regulations, which have been promulgated by the government of Prussia:

1. School physicians are to be appointed to all the schools of all the communities, large and small, and children without exception shall be subject to medical supervision.

2. Children must be examined by the physician upon admission to school; at least once during the school life, and be given a final examination upon leaving school on account of the choice of a profession.

3. Weak and sickly children are to be continuously superintended.

4. The school physician shall also have the oversight of the health of the teachers and janitors, and he shall be the expert counsellor of the board of education in all questions of school hygiene; he shall have a vote in the board of education, and in the teachers' training school he shall be the instructor in physical training and school hygiene.

In an enterprising school district in a western state, the school physician by energetic measures secured the immunity of the children of a district from diphtheria, while at the same time an epidemic wrought havoc in adjoining districts. The demonstration made it easy for the school boards to secure the necessary support for systematic inspection by salaried physicians. The general results have shown that the progress of many children in their school work is hindered by minor

physical defects which can readily be remedied. The uniform results of trial in different parts of the country have been such as to justify the contention of the early advocates of medical inspection, and the next step in the movement will be the organization of the work throughout the country.

In New York city it has been found that the force of approximately 100 physicians and 200 nurses will be wholly inadequate to handle the problem. Dr. Cronin, of that city, is of the opinion that there should be one physician and one nurse to each 2,000 pupils. In many of the cities of the country some local physician is paid a small annual salary for examining the children of one or more schools. There are practical reasons why the school physician should be a full-time salaried official who does not combine private practice with school inspection work. This plan is the general requirement in the English cities and country districts, and if adopted in this country it will open a field which will call for from six to ten thousand medical inspectors of schools.

The pay for service of this kind varies greatly. In New York city full-time medical inspectors are paid salaries ranging from $1,200 to $3,000; in Philadelphia the pay is from $1,400 to $2,400 with a chief inspector at $4,000; in Boston from $800 to $2,850; in Pittsburgh from $1,200 to $2,400. These schedules will attract young men at the beginning of their medical careers, but it is not likely to hold them longer than for a few years. The salary schedule is more likely to prove acceptable to women, and for this and many other obvious reasons this field is sure to become an attractive one to women graduates from the recognized medical colleges.

CHAPTER XX.

MEDICAL MISSIONS.

The mission boards or religious denominations send medical missionaries, men and women, to non-Christian countries as advance guards of the physicians of souls. Through these men, who minister to the physical distresses of benighted people, these organizations hope to establish such confidential relations and to convey such evidences of good will, that the work of the preacher of righteousness may be made easier and more far reaching.

As compared with the uncertain results of the crude treatment of unlearned native doctors, the medical missionary's skill in the art of healing is regarded by the ignorant and superstitious people with amazement and wonder, and his reputation soon spreads far and wide; so that both laborers and court dignitaries come to consult him.

It is true that European countries maintain in their colonial possessions, in connection with their official establishments, some trained physicians, but the influence of these men is confined to official stations and military posts; and in many populous districts there are millions who are never benefited by modern scientific medicine until the advent of the medical missionary.

After their establishment in a given locality, these medical missionaries spend much of their time as itinerants, thus increasing the area of their influences. In