Many think the acme of medical practice is surgery. Others look with scorn upon the surgeon, declare him to be only a technician, and think the greatness of a medical career depends on laboratory precision or on diagnosis and treatment. But to me the field of endeavor par excellence is the realm of preventive medicine. Such is the work of the school physician.*
It is not expected of the school physician that he always have access to the facilities that assist in the accurate diagnosis of disease, that he fit the child with glasses, or that he operate for appendicitis. Nevertheless he serves in important and specific fields, such as:
1. Instructing the children in proper health habits.
2. Inspection for physical defects or cOntagious disease.
3. Contacts with private doctors or clinics for correction of defects.
4. Contacts with parents through health programs and parent-teacher associations.
5. Personal guidance for individual pupils in their individual problems.
6. Inspection and advice on grounds and buildings.
7. Co-operation with the health department concerning immunizations, tuberculin testing, etc.
8. Guarding teacher health.
From the foregoing one can conclude that the work of the physician involves co-operation with many other agencies and individuals. Diagrammatically the ideal school-health program would look like the arrangement that appears on page 27.
Naturally we are far from this ideal. Many workable plans are being carried out, however, and improvements are being made. The nurse can well take care of the details of organization. A part-time physician who engages in the treatment of acutely ill patients is obviously an excellent person for a school doctor. In his varied capacities he is able to see the final outcome of uncurbed habits and flagrant disease, in comparison with its more insidious form, in the apparently well school child or young adult.
When we contemplate, for instance, the whole train of diseases that may follow an ordinary "common cold," we begin to have respect for it. If the school physician did no other work than to eliminate colds from the campus, his efforts could be easily justified. Colds are highly contagious, they definitely lower resistance, and may be followed by pneumonia, sinus infection, otitis media, mastoiditis, tonsillitis, pharyngitis, bronchitis, tuberculosis, and in the allergic child are often the precursor of asthmatic attacks. The evils they bring are too many to enumerate. A cold should be isolated the same as measles.
Poor posture is another health problem, the far-reaching influence of which is seldom realized. Visceroptosis, abnormalities affecting childbirth, physiological knock-knee, flatfoot, backache, improper oxygenation of the blood, pelvic congestion, fatigue, and loss of morale are some of the effects of improper posture.
Diet requires constant supervision and early training. In this day of "snacks," such as "cokes," ice cream, and candy bars, to say nothing of cigarettes and alcoholic beverages, an almost Spartan attitude must be instilled in the little child. And let us repeat that it must be instilled in the child. It is almost impossible for parental or teacher supervision to regulate the diet of a school child entirely. For any health habit, proper public opinion must be established in the school, and the child must earnestly desire to live right because of the benefits to be derived from so doing.
Recently I observed a family who presented the picture of rickets and multiple vitamin deficiency. These children were rather plump, but nevertheless malnourished, with poor skin turgor, knock-knees, and decayed teeth. I asked the mother whether she was able to obtain milk, orange juice, fresh vegetables, etc. To all this she replied, "No, we are too poor."
I then asked, "How about jams and jellies —do they get much of that?"
"Oh, yes," she replied, "they have a lot of that." She also told me with great pride that they had ice cream and candy when they could possibly manage to get it. After I had explained that children need certain simple foods, she said, "Do you mean to tell me that what they eat makes them like this ?"
The child must be taught about food. He must be shown the effects of impoverished diets on rats, and must learn the value of proper nourishment by other object lessons.
Inspection by the school physician is of necessity somewhat cursory. There are, however, so many gross defects among our children that even this examination is of great value. Some things frequently observed are carious teeth, diseased gums, defects in hearing and vision, heart ailments, diseased tonsils, postural defects, uncleanliness, nail biting, malnutrition. An outstanding case that comes to mind is that of a little girl who had blindness in one eye, from disuse. This trouble had not been previously suspected, even though the child came from a family of the upper stratum. Deafness is often passed up before inspection, since children readily learn to lip-read.
I believe it is wrong to represent to the parents that any child is perfect on the basis of a school inspection. This service is not meant to take the place of private medical care. Often the defects noted must be checked into more thoroughly by the private doctor or free clinic. The private doctor may find defects not noted at all in the school examination. Corrective work as a rule belongs to private .dentists, doctors, or clinics.
On the other hand, I think it is a mistake for parents to refuse to have their child inspected at school, just because he is already taken care of healthwise. As mentioned before, it is highly essential for the child to be health-minded. The physical inspection is just another way to keep health in the school atmosphere. At this time the doctor and the nurses have a chance to discuss proper hygiene and correction of defects with the pupils, and enlist each room to try to keep the health habits and become Ioo per cent fit. This co-operative movement gives impetus to remedial endeavor.
When children really become interested in a problem, they manage to interest their parents. Talks to parent-teacher associations will often help to stimulate fathers and mothers who are a little apathetic about their children's health. Moving pictures are also effective.
Our work is being continually crippled because of the cripples among us. Let us remove this stigma. If the school physician could look around at the workers in the missi field and see a boy or girl whom he had saved from disease, then I believe that would be more reward than wealth or fame.
* The Doctors Pitman are now under appointment to the Chulumani Sanitarium and Hospital in Bolivia.
