Chapter 3

7. School playgrounds, which afford space, facilities, opportunity, and incentive for the expression of play instincts and impulses.

8. Organized athletics, which aid in physical development, and afford training in alertness, intense application, vigorous exertion, loyalty, obedience to law and order, self-control, self-sacrifice, and respect for the rights of others.

9. Systematic instruction and practice in personal and community hygiene and sanitation.

10. The progressive improvement of all adjuncts of better sanitation in school houses, such as sanitary drinking cups and fountains, systems of vacuum cleaning, improved systems of lighting, heating, and ventilation.

HEALTH AND EDUCATION AND BUSINESS

There is one condition in the Cleveland school system which rises like a mighty barrier against the possibility of completely fulfilling any such program of health education as that outlined in the 10 planks of the preceding platform. This is the fundamental fact that the Cleveland school authorities have not yet conceived of health work as being an integral part of education.

In this city the work of the Board of Education is divided into three main departments. These are the executive department, the educational department, and the department of the clerk. The executive department is under the leadership of the director of schools and it deals with the business activities of the Board. The educational department is under the superintendent of schools and deals with teaching.

Under this organization the activities carried on by the Board of Education must be assigned to one or another of the departments and this entails in most cases arriving at a decision as to whether the work in question is predominantly of an educational nature or of a business nature. In dealing with health work in the public schools, the Board of Education rendered its decision both ways. It decided that provision for health in education was a series of business transactions and so it placed medical inspection in the executive department under the leadership of the director. It also decided that provision for education in health was a teaching problem and so it placed physical education and training in physiology and hygiene under the direction of the superintendent of schools.

Despite its decision that provision for health in education is a business matter, while provision for education in health is a teaching matter, the Board realized that some sort of unity was essential if the different sides of the work were carried forward efficiently. They met this situation by employing a competent director of health work and giving him an official dual personality. As the official held responsible for health in education, he is the director of medical inspection and is subordinate to the director of schools. As the official responsible for education in health, he is an assistant superintendent and is responsible to the superintendent of schools. In one capacity he is appointed by the superintendent and receives a portion of his salary from educational funds. In his other capacity he is appointed by the director of schools and paid from business appropriations. As an employee of the educational department, he is appointed for a term of one year, but as an employee of the business department, he is on the civil service list with an indeterminate period of employment.

In his educational capacity, he may arrange for the organization of basketball teams for this is held to be a matter of physical education, but in order to have a basketball game actually played at any time outside of regular school hours, he must get the permission of the director, for this is held to be a business transaction.

Instruction in infant hygiene is given to the girls in the upper grades. Part of the teaching is done by the regular teachers, the rest by the nurses of the medical inspection department. When the instruction is given by the teachers, it is considered an educational activity and is under the supervision of the superintendent; when the same class is taught by the nurse, it is considered a business transaction and is under the authority of the director.

As chief medical inspector, representing the business department, this official discovers a feeble-minded child whom he wishes to transfer to a special class. Since the transfer of this child is an educational problem, he reports the matter to the assistant superintendent in charge of the district. Since the medical inspector is also an assistant superintendent, these two men are co-ordinate educational officials. The assistant superintendent of the district reports the requested transfer to the city superintendent who deals with the matter as an educational problem and issues an order to the chief medical inspector in his capacity as assistant superintendent in charge of physical education to make the transfer.

This whole situation, which arises from assigning some phases of the health work to the business department and other phases to the educational department, has not given rise to as many or as serious difficulties as might well be expected. This relative freedom from trouble and friction is an impressive tribute to the unremitting tactfulness of the officials most directly concerned. The chief medical inspector is a conspicuous example of a man defying holy writ by successfully serving two masters.

Health work in Cleveland public schools is on a higher plane than in most other cities. Its present accomplishments have carried it further than similar work has gone elsewhere. Its future possibilities are unusually bright because the early stages of development have been successfully passed. The one thing that we may be sure of is that this future development will tend toward an ever closer relationship and more intimate intermingling of the activities which make for health in education and those which are directed toward education in health. Each new development and each forward step renders a separation of the work into educational and business activities progressively difficult.

To discover decayed teeth and to teach children to care for their teeth are intimately related matters and their separation is bound to be theoretical and not real. To attempt to separate the testing of vision from teaching concerning the conservation of vision is to lose an opportunity for the most effective sort of instruction. Similarly, if one scrutinizes all of the 10 items that have been suggested as indicating the health activities which Cleveland should continue to develop in its public schools, he can hardly fail to appreciate the utter impossibility of successfully dividing the work into certain activities which shall be educational and certain other activities which shall be business. Sooner or later the theory that this can be done will be destroyed by the logic of events, for health work in our public schools is constantly becoming a more intimate and integral part of the every-day education of all the children.

Sooner or later serious difficulties are bound to arise from an administratively unsound arrangement in which a school official in charge of a most important division of work is responsible to two entirely independent chiefs. The opportunities for honest but irreconcilable conflict of views are so numerous that they will surely arise in time. One chief may favor vaccination and the other be opposed to it on principle. One may deem it the duty of the schools to have the doctors and nurses give instruction in sex hygiene while the other may be utterly against anything of the sort. One may hold that the only useful physical exercise is that gained through games and athletics, while the other may favor formal gymnastics. One may believe in school gardens, and the other deem them a waste of time and money. One may believe that courses in infant hygiene should be provided for the girls in the upper grammar grades, while the other may hold that such instruction should be reserved for continuation classes for young women.

All of these are matters on which educational authorities are sharply divided in opinion and there are many more of the same nature. The present director of schools, the present superintendent of schools, and the present chief medical inspector have so far worked successfully under the present arrangement of divided duties and responsibilities, but a reorganization along sounder administrative lines should be made before, instead of after, serious trouble arises. Eventually, if not now, Cleveland must realize that health work in education must be placed under the direction of the city's highest educational official who is the city superintendent of schools.

SUMMARY

1. Cleveland employs 16 school physicians, one oculist, and 27 nurses. It spends $36,000 a year on salaries and supplies for these people, and maintains 86 school dispensaries and clinics.

2. Through medical inspection, the educator and the physician join hands to insure for each child such conditions of health and vitality as will best enable him to take full advantage of the free education offered by the state. It recognizes the intimate relationship between the physical and mental conditions of children. It realizes that education is dependent upon health. It betters health conditions among school children, safeguards them from disease, and renders them healthier, happier, and more vigorous.

3. The first work of this kind in Cleveland started in 1900 when tests were made of defective vision. In 1906 the Health Department provided inspectors for contagious diseases in the schools. In the same year inspection for physical defects was undertaken; the first dispensary in the United States was established at the Murray Hill School, and school nurses were appointed. In 1909 the Division of Health Supervision and Inspection became part of the regular school system.

4. The Division handles inspection for contagious disease, inspection for physical and mental defects, follow-up work for the remedying of defects, health instruction, recommendations of children to special classes, school lunches, gardens, and playgrounds. Every child is examined every year.

5. Cleveland has 86 dispensaries. In every case lighting, ventilation, and equipment are good. It is probably true that these dispensaries are of better grade than those of any other large city in the United States.

6. Dental clinics are now conducted in four public schools by the Cleveland Auxiliary of the National Mouth Hygiene Association. This work has now reached a point where it should be taken over and administered as a part of the public school system. The function of a private organization is to experiment and demonstrate. It cannot eventuate on a large scale, and it should not if it could. The function of a public organization is to eventuate on a large scale. It can seldom experiment, and it lacks freedom and flexibility in demonstration. The Mouth Hygiene Association has experimented and demonstrated successfully. Its work should now be assumed, continued, and extended by the Division of Medical Inspection.

7. The eye clinic conducted by the Division at the Brownell School is doing excellent work. As the system grows, this clinic should be supplied with more workers. The Cleveland College for Barbers gives an excellent free service in many of the schools. There are no other clinics. Mental examinations are made by a special teacher appointed for that purpose. All surgical cases are referred to family physicians or local hospitals for treatment.

8. Medical inspectors are mature men, graduates of well-known medical schools, with a fairly wide private practice. The school nurses are all registered nurses.

9. The number of school nurses should be increased as rapidly as possible until one nurse is provided on full time for every 2000 children enrolled in school. This would mean the employment of 11 additional nurses, increasing the staff from 27 to 34. As the population increases, more nurses should be added.

10. Office consultations between parents and physicians are among the most important activities of the Division and should be systematically encouraged. To this end arrangements should be made whereby definite hours for parent consultations are assigned to each school.

11. The Division of Medical Inspection has so organized its work that the attention of the staff is concentrated upon a different set of problems each year. This method is unquestionably effective in promoting growth and maintaining the interest of the staff. Care should be taken, however, to provide that within each four-year period special emphasis be laid upon the discovery and cure of each of the more important defects. Some plan should be adopted by the staff whereby effort may be concentrated on discovering and remedying defects at those ages where such expenditure of time and energy will secure the largest returns.

12. Adequate provision should be made for the correction of speech defects. Classes in speech training should be established under the direction of a teacher specially trained in this work.

13. Standardization of work is an especially noteworthy feature of the Cleveland system, and should furnish valuable suggestions to medical inspection departments of other cities. Through this standardization the same terms have uniform meanings when used by different members of the staff, and constant standards are employed in detecting and recording defects.

14. There are probably more than 50,000 unvaccinated children now in the Cleveland schools. Immediate steps should be taken to see to it that every child now in school is vaccinated, and that no child is admitted to school hereafter without similar protection. Principals, teachers, and parents should be held responsible for violation of the vaccination ordinance.

15. The Division of Medical Inspection should plan steadily to enlarge its field of activity in order to provide in constantly increasing measure better working conditions in the schools and to train the children into habits of health that shall be life-long. It is probable that the health work in the Cleveland public schools is unsurpassed by that of any other city in the country. The city now has an opportunity to lead the way into vastly important forward extensions looking toward the provision of health insurance for future generations.

16. Under the present organization, the official in charge of health work is responsible to the director of schools in part of his activities and to the superintendent in the rest of them. He should be responsible to the city superintendent alone, for health work in the public schools is education and not business.

CLEVELAND EDUCATION SURVEY

SECTIONAL REPORTS

These reports can be secured from the Survey Committee of the Cleveland Foundation, Cleveland, Ohio. They will be sent postpaid for 25 cents per volume with the exception of "Measuring the Work of the Public Schools" by Judd, "The Cleveland School Survey" by Ayres, and "Wage Earning and Education" by Lutz. These three volumes will be sent for 50 cents each. All of these reports may be secured at the same rates from the Division of Education of the Russell Sage Foundation, New York City.

Child Accounting in the Public Schools--Ayres. Educational Extension--Perry. Education through Recreation--Johnson. Financing the Public Schools--Clark. Health Work in the Public Schools--Ayres. Household Arts and School Lunches--Boughton. Measuring the Work of the Public Schools--Judd. Overcrowded Schools and the Platoon Plan--Hartwell. School Buildings and Equipment--Ayres. Schools and Classes for Exceptional Children--Mitchell. School Organization and Administration--Ayres. The Public Library and the Public Schools. The School and the Immigrant. The Teaching Staff--Jessup. What the Schools Teach and Might Teach--Bobbitt. The Cleveland School Survey (Summary volume)--Ayres.

* * * * *

Boys and Girls in Commercial Work--Stevens. Department Store Occupations--O'Leary. Dressmaking and Millinery--Bryner. Railroad and Street Transportation--Fleming. The Building Trades--Shaw. The Garment Trades--Bryner. The Metal Trades--Lutz. The Printing Trades--Shaw. Wage Earning and Education (Summary volume)--Lutz.

[Transcriber's Note:

The following type-written material was attached inside the front cover of this book and is included here for its historical interest.

DIVISION OF MEDICAL INSPECTION and PHYSICAL EDUCATION CLEVELAND

Dr. E. A. Peterson Director

Mr. H. P. Kimmel Secretary

Henry W. Luther Supervisor of Physical Training

Louise Klein Miller Curator of School Gardens

Anna L. Stanley Supervisor of School Nurses

Charlotte Steinbach Examiner of Atypical Children

Lola Barnard Ass't. "

Mabel J. Winsworth Supervisor of School Feeding

Hannah Spero Stenographer

THE CLEVELAND FOUNDATION SURVEY ROOM 25. 612 ST. CLAIR AVE, N. E. CLEVELAND, OHIO

November 18, 1915.

The next meeting of the Advisory Committee of the Education Survey will be in the Assembly Room of The Hollenden, Monday, Nov. 22nd, 1915 at 12. The section of the Survey to be considered will describe a feature of school work in which Cleveland equals any and excells most cities of the country.

Subject: HEALTH WORK IN THE PUBLIC SCHOOLS Speaker: LEONARD P. AYRES, Director Education Survey.

You are invited to bring any interested friends and are urged to be prompt so as to give full time for both the luncheon and the discussion.

Please reply on enclosed card.

Yours truly, F. F. Prentiss, Chairman. Allen T. Burns, Director.

End of Transcriber's Note]