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Reform of NYC Public Schools, 1896

In a paper on "Medical School Inspection" printed in the New York Medical Journal, February 10, 1900, the following statement occurs, "The objective point in the system is exclusion." Now, in the same month in 1903, the system has undergone such changes that the objective point is quite the reverse namely, to keep the child in school, and at the same time have the treatment carried on systematically until a cure is effected. This is due to the presence of nurses in the schools.

Under the old regulation, when the teacher sent a child suffering from some contagious disease, such as ringworm, to the doctor, and he excluded the child from school, their duties were finished. The child possibly took his card home and no attention was paid to it, and when needed it could not be found. He, in the meantime, played with the other children on the street until he got well or until the truant officer, found him,

Now, instead of being sent out of school lie is taken to the nurse, who promptly washes the sore spot with a tincture of green soap and water and applies a coating of flexible collodion. After this kind of treatment for a few days the "ring" disappears entirely. The collodion having stopped the spread of contagion, he is practically as safe as the others.

By means of the card system now in use it is almost impossible for the children to be neglected if everyone does his duty. The diseases are arranged in code form, each disease having its own particular number. These numbers are placed on an index card, which also has dates, when ordered under treatment, when under treatment, exclusion, readmission, and also the class and room number and school. This is signed by the Medical Inspector and left on file for the use of those requiring this information. The routine inspection is made once a week by the doctor, who goes into the classroom, stands with his back to a window, and as the children pass before him lie looks at the eyes, throat, hands, and hair of each individually. On other days at an appointed time he visits the school, and those who have returned after an absence of several days, or any who have the slightest indication of any contagious disease, or who have returned after being excluded by the doctor, are sent to him. Those who can be cared for by the nurse are sent at once to her, the others being either returned to their classrooms or sent home, as the case demands.

During the one hundred and twenty school days from January until June, when vacation began, the number of treatments given was one hundred and thirty five thousand eight hundred and fifty four, there being twenty three thousand one hundred and ninety-one children with different diseases. To show from what children suffer most I will quote a few figures for the Borough of Manhattan alone, where there are sixteen nurses: Contagious eye diseases, sixty five thousand nine hundred and eighty seven; pediculosis, fifty-five thousand six hundred and thirty-one; ringworm, six thousand and fifty-seven; eczema, two thousand two hundred and eighty-five; scabies, one hundred and sixty-three; miscellaneous, five thousand seven hundred and thirty-one, which includes anything not on the code, such as cuts, wounds, etc.

Trachoma...is not treated at any time by the nurses. The simple washing out of the eye has very little effect on the disease, if any, and is a source of contagion unless the strictest precautions are observed. The acute conjunctivitis and the purulent forms are thoroughly cleansed with a boracic-acid solution, and besides this treatment in school the mother is visited and a practical demonstration is given with the advice to repeat the treatment at regular times.

Eczema, scabies, and impetigo are treated according to the schedule given [by the New York City Department of Health]. Pediculi succumb readily to the kerosene and sweet oil. The potassium carbonate aids in getting off the oils and dirt. The vinegar heated and applied loosens the "nits," when they can be brushed or drawn off by a piece of cloth. This means a lot of labor for the mother, but as they are anxious for their children to be clean every effort is made. That the work is needed is seen by the many requests from teachers and doctors asking for nurses in schools where they have none.

While much has been done, there is still more to be done. We hope to have every school in the city supplied with a room and other essentials, as well as having a nurse. Not the least part of education is the instruction given to the mothers in homes in cleanliness and the smaller details of nursing.

It is hoped that other cities may find it part of their educational system which they cannot neglect, and that in a very short time the work will be universal.