HEALTH NEWS

MAY, 1916

A DIFFICULT PROBLEM IN PUBLIC HEALTH WORK School medical inspection has two definite aims: first, the early recognition and exclusion from school of children suffering from acute communicable disease, as a prime factor in the control of local epidemics; second, the recognition of physical and mental defects and abnormalities among the pupils, followed by the institution of remedial measures.

It must be acknowledged that city school children are vastly better off in this respect than those who attend rural schools. Medical inspection in the large cities has reached a high degree of proficiency, whereas in rural communities it is largely a perfunctory procedure, frequently conducted by physicians without the knowledge and experience which the work requires.

Nevertheless, even with the forces at hand, a much greater proficiency may be attained by impressing upon every community the extreme importance of this work to the present and future welfare of the children; by hearty cooperation between local health and school officials; by systematic instruction of school teachers and pupils in the elements of hygiene and recognition of disease; by the appointment in each school district of that physician who by knowledge and experience is best equipped for the work, for which he should receive suitable compensation. He should also, if necessary, be encouraged and given an opportunity to acquire such knowledge as he may lack in the recognition of infectious diseases and abnormalities of the throat, nose, eyes, ears and internal organs.

COOPERATION IN MEDICAL SCHOOL INSPECTION

LINSLY R. WILLIAMS, M.D.

Deputy Commissioner of Health

Since the enactment of the amended Public Health Law in 1913 and of the amendments to the Education Law relating to the physical welfare of school children in the same year, a number of apparent conflictions of authority have from time to time arisen. So many questions have come up as to the respective duties of the health officer and the medical school inspector that it is advisable at this time to define as closely as possible the duties of each office and also to point out the methods to be used in following up children absent from school presumably on account of a communicable disease.

It should be remembered that the Education Law was enacted subsequently to the amendments of the Public Health Law and by implication amends and takes the place of Paragraph 2 of Section 21-b of the Public Health Law. According to the Law as interpreted by the Department of Health a school medical inspector should be appointed for each school district to examine children who have not had a health certificate given them after examination by their family physician. Section 575 of the Education Law further provides that pupils who upon investigation show symptoms of certain communicable diseases shall be excluded from school and the health officer notified. The Law does not specify who shall make this investigation, but it does provide that the school medical inspector shall examine each pupil returning to school without a certificate from the health officer of the city or town, or the family physician.

Exclusion from school

Children may be excluded from school according to the Sanitary Code and the Public Health Law when they are presumably affected with a communicable disease. Teachers throughout the State may receive from the State Department of Health a pamphlet entitled, "The Teacher and Communicable Disease" which will be of great value to them in excluding children from school. Children may also be excluded by the principal or by the school medical inspector or the health officer. When a child is excluded from school for one of the diseases enumerated in either the Sanitary Code or Section 575 of the Education Law the child should be given a card by the principal or teacher notifying the health officer that the child was sent home apparently affected with symptoms. suggestive of such and such a communicable disease. In order to return to school the child, in accordance with Section 575 of the Education Law,

shall have a card signed by the family physician, health officer or school medical inspector. School authorities should remember that unless such cards are provided and unless the child or its parents are advised as to the conditions on which the child may be allowed to return to school, the latter may lose a certain part of school time, or the parents be put to additional medical expense.

Outbreaks of communicable disease

Communicable disease can not be controlled without efficient work and hearty cooperation on the part of both the school medical inspector and the health officer. The school medical inspector is required by law to notify the health officer of every case of communicable disease which occurs in a school child. Conversely, the health officer should report to the school medical inspector every case of communicable disease which occurs in a family in which there are children of school age. What is perhaps more important is the visiting of families in which a child of school age is absent from school. Children are frequently absent from school on account of one of the milder communicable diseases, and as the family has not engaged a physician, the disease is not reported to the health officer and there is no medical or sanitary supervision of the case. School authorities will find it of extreme value to have a school nurse or attendance officer to follow up absences from school, and thus frequently discover cases of communicable disease. Whenever the school nurse or attendance officer discovers a child ill with a disease which may be communicable it is her or his duty to report promptly all the facts to the school medical inspector who if diagnosis is confirmed will report to the local health officer. In the absence of the school medical inspector the cases must be reported directly to the health officer. It is the health officer's duty to visit all cases of disease which are reported to him as being possibly communicable in order that proper sanitary precautions may be taken. It is not the health officer's duty to visit cases of sickness unless there are sufficiently good reasons to believe that the case may be one of communicable disease.

It will be found of great advantage to the school nurse or attendance officer to keep a small notebook in which may be recorded the name, age and address, the names of members of the family attending school, and the name of any child who may be absent from school on account of communicable disease. The school medical inspector should also keep a notebook with a list of cases of communicable disease diagnosed by him and reported to the local health authorities.

On the other hand the health officer should not only investigate and visit every house where a case of communicable disease is reported or suspected of being present, but he should also make a list of the names of

all the persons who live in the house, and this list should be kept and the house revisited from time to time in order to ascertain whether or not quarantine is being observed. If a communicable disease exists in epidemic form in any community it is usually wiser not to close the school but to keep the various classes under daily supervision and to exclude promptly persons suspected of developing the disease. It will usually be found preferable to exclude a certain class or classes from school rather than to close the entire school. Whenever an outbreak occurs it is recommended that the school medical inspector shall make a daily visit to the school and inspect all the children, and the health officer will be expected to cooperate with him and render all assistance possible, but it is believed that it is the primary duty of the school inspector to perform this service.

Before making examinations of children, whether for an ordinary physical examination or for the presence of a communicable disease, the usual aseptic precautions should be taken, and for examining the throat an ample supply of wooden tongue depressors provided and also facilities for sterilizing thermometers. Physicians and nurses should use extreme care that the hands are thoroughly washed after an examination of the nose and throat.

At the close of an epidemic, terminal fumigation is not necessary, but the schoolroom or rooms where cases of communicable disease have been detected, should be thoroughly scrubbed with soap and hot water, followed by a thorough airing. During the existence of an epidemic it is of great advantage to have warnings issued in the press and also to publish bulletins referring to the fact that the Public Health Law requires heads of families to report to the health officer suspected cases of communicable disease in their own households.

Rules and regulations for health officers and medical school inspectors for the control of communicable disease

I Whenever a school teacher, a school medical inspector, school nurse, or attendance officer discovers that any school child absent from school is affected with any disease presumably communicable, he or she shall report forthwith to the local health officer all known facts relating to the illness of the child, together with the name, age and address of such child, and the name of the physician, if any, in attendance.

2 When no physician is in attendance, it shall be the duty of the local health officer to investigate the nature of the illness of every person within his jurisdiction reported to him as affected with a disease presumably communicable.

3 Whenever a case of communicable disease occurs in any school, it shall be the duty of the school medical inspector to immediately notify

the health officer of such case and to ask his cooperation and assistance in controlling the disease in said school.

4 Whenever a case of communicable disease occurs in any school in his jurisdiction it shall be the duty of the health officer to render every assistance possible to the school medical inspector in the control of said disease.

5 Whenever a case of communicable disease occurs in any school and there is no school medical inspector directly responsible for the prevention and control of communicable disease in said school, it shall be the duty of the local health officer to take all steps necessary to prevent the spread of the disease.

6 Whenever a child in attendance at school is reported to the school medical inspector by the school nurse or teacher as being affected with a disease presumably communicable, it shall be the duty of the school medical inspector to examine the child promptly, and if such child is affected with a communicable disease the school medical inspector shall report immediately to the local health officer all the facts relating to the illness, together with the name and address of such child.

7 Whenever a case of communicable disease, in a family with a child. or children of school age, is reported to the local health officer, it shall be the duty of the local health officer to notify the school medical inspector promptly of the name, age and address of such child or children and the nature of the communicable disease, and also of the names and ages of all other children in the same household.

JOHN H. FINLEY,

Approved April 25, 1916.

Commissioner of Education,

HERMANN M. BIGGS,

Commissioner of Health.

The following extracts from the Education Law and Sanitary Code are also applicable:

Education Law

$575. Existence of contagious diseases; return after illness. Whenever upon investigation a pupil in the public schools shows symptoms of smallpox, scarlet fever, measles, chickenpox, tuberculosis, diphtheria, influenza, tonsilitis, whooping-cough, mumps, scabies or trachoma, he shall be excluded from the school and sent to his home immediately, in a safe and proper conveyance, and the health officer of the city or town shall be immediately notified of the existence of such disease. The medical inspector shall examine each pupil returning to a school without a certificate from the health officer of the city or town, or the family physician, after absence on account of illness or from unknown cause.

Such medical inspectors may make such examinations of teachers, janitors and school buildings as in their opinion the protection of the health of the pupil and teachers may require.