The physicians to do good work or even to hope to efficiently accomplish the manifold purposes of medical school inspection. It is obvious that one physician assigned, as he often is, to three schools, with an attendance of from five to ten thousand children, cannot do more than routine perfunctory work. Even if there were assigned to each school three full-time physicians, the enormous amount of work could not be accomplished without the active aid and participation of trained school nurses. Therefore, there is great need for the appointment of many additional trained nurses for our schools.
Inspection for Detection of Physical Defects and Detention of Cases of Contagious Diseases. — A school nurse should be familiar with the height and weight charts of children and should be able to detect physical defects common to children. She should also be familiar with the symptoms of various contagious diseases with a view of their early detention and, at least, detention of those children who present suspicious symptoms for a more thorough diagnosis by the physician.
Physical Defects. — The physical defects common to children in school are the following: Defective vision. Defective hearing. Defective nasal breathing. Hypertrophied tonsils. Tuberculous lymph nodes. Defective teeth. Malnutrition. Chorea. Orthopedic defects. The more serious cardiac and pulmonary defects will be detected by the physician on his thorough examination of the child. Defective vision and hearing may be detected by the application of simple tests. Defective nasal breathing and hypertrophied tonsils may easily be detected by inspection and examination of nose and throat. Tuberculous lymph nodes are detected by inspection and palpation.
<Callout type="important" title="Critical Rule">Cases of acute conjunctivitis, trachoma cases, certain skin diseases and pediculosis without live pediculi may be allowed to attend school while under treatment, either by a private physician, a dispensary or the school nurse.</Callout>
Contagious Diseases. — The nurse on visiting each school should inspect the room which is assigned for the purpose of inspection, the children. The following contagious diseases are to be looked for:
<Callout type="risk" title="Risk of Contamination">Cases of acute conjunctivitis, trachoma cases, certain skin diseases and pediculosis without live pediculi may be allowed to attend school while under treatment, either by a private physician, a dispensary or the school nurse. However, contagious skin diseases with extensive lesions, pediculosis with live pediculi, and all general contagious diseases are excluded from school attendance.</Callout>
Home Visit. — The nurse must exercise great tact in her visits to the homes of children who are absent from school. The purpose of such visits is to discover the cause of absence and the possible presence of contagious diseases and attendance at school of some members of the family. The nurse should not play the role of detective but rather that of a family adviser and counselor.
Emergency and First-aid Treatment. — In the absence of the school physician all emergency cases are treated by the nurse in the school, whenever other treatment is not available. Slight or more severe injuries, cuts, results of falls, and other accidents occurring to school children in the school building should be promptly treated by the school nurse. It would be well if every school would provide a first-aid and emergency treatment room with the proper and necessary equipment and appliances.
Children should be instructed to apply to the school nurse for the application of tincture of iodine for every slight scratch or cut in order to prevent possible septic infection.
Advice as to Physical Defects. — Defects of the Mouth and Teeth. — (a) If the child's teeth are decayed it should be taken to a dentist at once. (b) The teeth should be brushed after every meal, using a tooth brush and tooth powder. The following tooth powder is recommended: 2 ounces precipitated chalk. I ounce powdered castile soap. 1 dram powdered orris root. Mix thoroughly. This prescription can be filled by any druggist at a cost not to exceed fifteen cents. The child should take the toothbrush and powder to the school and receive instructions from the nurse as to their proper use.
Defective Vision (and Hearing). — Proper advice should be given to the children if defects in hearing; and vision are discovered. A more thorough examination should be made by the physician with the view of prescribing exact treatment for remedying the defects, errors of refraction should be corrected by properly fitted glasses. Special attention should be paid to any discharges from the ears as these may be symptoms of serious and contagious diseases.
Malnutrition. — Proper advice and counsel should be given to the child in case of manifest malnutrition, correction of the dietary and advice to mothers as to proper feeding may be in the province of the school nurse. Anemia and malnutrition, when extreme, should be taken in hand by the physician and the child referred to special open-air classes and other methods employed for the cure of these conditions.
Treatment by Nurse of Certain Contagious Diseases. — Pediculosis. — A child affected with live vermin of the head or body should be excluded from school. The best treatment for the destruction of body lice is the boiling of the underwear of the child and fumigation of the clothing. The bathing of the child and instruction in cleanliness should follow the preliminary treatment.
<Callout type="tip" title="Pro Technique">If the head is shampooed regularly each week as above described, it will cure and prevent the condition of nits.</Callout>
Itis. — Wash with tincture of green soap and cover with flexible collodion. Severe cases: Scrub with tincture of green soap, paint with tincture of iodine and cover with flexible collodion.
Ringworm of Face and Body. — Wash with tincture of green soap and cover with flexible collodion.
Scabies. — Wash with tincture of green soap and apply sulphiu- ointment.
Impetigo. — Remove crusts with tincture of green soap and apply white precipitate ointment (ammon. hydrag.).
Molluscum Contagiosum. — Express contents: Apply tincture of iodine on cotton-covered toothpick.
Conjunctivitis. — Irrigate with solution of boric acid.
Trachoma. — Trachoma is not treated by the nurse. Children so affected are instructed as to the necessity for treatment, as per following instructions:
<Callout type="warning" title="Safety Hazard">Instructions to Parents Regarding Trachoma.- Trachoma is a contagious disease of the eyelids. If left untreated it is very dangerous to the eyesight. It first attacks the inner surface of the eyelids, later it spreads to the eyeball itself and causes loss of sight. In the beginning the eyes may be red and watery, and they may, from time to time, contain matter, but often for a long time there are no symptoms that the person notices, and the disease is frequently first discovered by the doctor. Trachoma is very difficult to cure, and it is the more difficult the longer the disease has lasted. For this reason trachoma should be detected as early as possible. It is contagious when secretion, that is to say 'matter,' is present. This secretion is for the most part conveyed by means of towels, wash-cloths, and handkerchiefs, and persons with trachoma should always be careful that their towels, wash-cloths and handkerchiefs are used by themselves. It is therefore not on the street that trachoma is transmitted from one person to another, but most generally in the home, and it is therefore in the home that the greatest precautions should be taken.</Callout>
Children who suffer from trachoma are not allowed to attend school unless they are regularly treated.
Key Takeaways
- School nurses play a critical role in detecting physical defects and managing contagious diseases among students.
- Early detection and treatment of contagious diseases are essential to prevent outbreaks.
- Proper hygiene practices, such as regular tooth brushing and head lice prevention, should be encouraged.
Practical Tips
- Regularly inspect school facilities for cleanliness and potential sources of infection.
- Educate students on proper handwashing techniques to reduce the spread of germs.
- Maintain a well-stocked first-aid kit in schools for immediate treatment of injuries.
Warnings & Risks
- Failure to properly manage contagious diseases can lead to widespread outbreaks among school populations.
- Incorrect use of medications or treatments may exacerbate conditions rather than improve them.
- Ignoring physical defects, such as vision and hearing issues, can have long-term consequences for students.
Modern Application
While the specific roles of school nurses and the methods described in this chapter are historical, the principles of early detection, prevention, and proper hygiene still apply today. Modern public health measures, such as vaccination programs and improved sanitation practices, have advanced significantly since 1917, but the importance of trained professionals to monitor and manage student health remains crucial for maintaining a safe learning environment.
Frequently Asked Questions
Q: How can school nurses prevent the spread of contagious diseases among students?
School nurses should regularly inspect classrooms for cleanliness, educate students on proper hygiene practices like handwashing, and promptly identify and manage cases of contagious diseases to prevent outbreaks. Early detection and treatment are key.
Q: What is trachoma, and how can it be prevented?
Trachoma is a contagious eye disease that can lead to blindness if left untreated. It spreads through contact with contaminated towels or handkerchiefs. Preventing trachoma involves using clean personal items and seeking regular medical treatment.
Q: What are the signs of trachoma, and when should a child be excluded from school?
Trachoma causes redness, swelling, and discharge in the eyes. Children with these symptoms should be excluded from school to prevent spreading the disease until they receive proper treatment.