publichealth-5 B

Transcriber:	Kaene Dino
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Date finished:	April 10, 2006
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So welcome back.

What I'd like to go on now and do is how we look on some specific policies that were developed to improve the health status of children towards the end of 19^th century and into the 20^th century. And we have to look at this in the context of the shifting role of children in society and the recognition of importance of health of children to the future health and strength of both nations and empires.

So let's begin by looking at the origins of the school medical service. As early as 1842, the French government issued a decree that all state schools in Paris have to be inspected by a physician. This is a relative ad hoc measure, and first organized school medical services were set up across Europe from 1870s onwards and you can see, in various places such as Brussels in 1874, Paris in 1879 and Lyon in 1880, formal school medical systems were set up. And as well as these city-wide systems in Sweden in 1878, a system was set up that covered the whole of the country. In some places the development was patchy and piecemeal, and other places such as Sweden the system that was set up which was very comprehensive.

Development was also sporadic in the United States and organized school medical service was set up in Boston in 1894. This was in direct response to an epidemic of dip Syria in 1894 when 50 physicians were appointed to examine children in schools who were inspected if having diseases. So the school medical service in this case was a direct policy response to appending epidemic threat. In New York in 1897 a home to 50 schools medical inspectors were appointed at a salary of 50 dollars per months to visit pubic schools and examine children suspected of having communicable diseases. So that in some senses reflected the type of the development that occurred in Boston in 1894. As you can see, with 150 school medic inspectors who were salaried and who were rather comprehensive set up.

And in Great Britain, school medical services were formalized by the Education Act of 1807. And by the end of 1909, medical inspection scheme has been established in almost all of the 328 British local authorities. So given that background you can understand that types of comments were emerging from public health officials at the beginning of the 20^th century. And one stand textbook on the hygiene of school life noted that the center of the responsibility, that's center of the responsibility for health, had shifted from the adult to the child. And so what you had, the shift characterized the move from the 1870s in Europe from a sanitary-based inspection, in other words, schools were inspected for the sanitary fitness, in other words, that drainage and that ventilation and so on, towards, from 1890s particularly in the United States, the inspection of individuals and individual children.

And what you have in that sense is a crude screening method for an infectious disease being gradually developed. And this crude screening method augmented developing network of local surveillance of infectious disease. And I will come to that crucial point later. Well I just want to continue a look in a little bit more detail at the outr prevention within school for school medical services.

And across Western Europe and North America, local authorities, local school authorities began to provide school medical services for the death of the blind and mentally and physically handicapped. And what these services tended to do as well as to provide for needy groups with also highlight the lack of services for other groups within the society who suffered from chronic illness and ailments. So it was reviewed when children came to be examined by school medical services that why the society was failing to provide for children who had cubic closious and who had skin complaints and who had problems with the other annoys.

A third feature of the school medical services was the idea to provider another additional layer of the inspection culture that had emerged during the period of environmental and sanitary reforms and will come back to that in a little while. And that becomes obvious when we look at these slides which show sanitary inspectors in New York just before the beginning of the 20^th century. And well, these inspectors are not specifically related to schools, they do provide the indication of the level of the intervention and connection of public health with inspection in a domestic level. And effectively school medical inspectors will perform precisely the same sort of functions both for schools.

So just to reemphasize, you have this move from the role of inspectors on a sanitary level to a role of school medical officers who is formally concerned with the health status of the individual children. As what was the responsibility that was developed on the school medical services are outlined in the slide. Every child tended to be examined on entrance to the school and it is the responsibility the school medical officer to ensure that the re-inspections of the children were taken on a regular basis. The school medical officer did also perform the traditional role of sanitary and school inspectors and they have to monitor the physical environments of the school, such as the drainage and ventilation system and so on. And as well as the inspecting the children on entrance to the school and re-inspection, school medical officers would also visit the schools during disease outbreaks. So it was a pending threat of sirce scholar fever outbreak or epidemic of dip Syria, and the school medical officers would visit the school, inspect children to see how there is any sign of the incipient disease.

And another crucial aspect of school medical officer was the examination of children who didn't come into school because they were ill. And the examination of the illabsentee took the medical officers out of the school environment and into homes and selves. So it became a very important channel for investigating the histories of diseases that might have originated in the domestic environment as opposed to school environment. So the school medical officers became a link between the home and the school in terms of the health status of the children.

And under the school medical services there was the development of specific school clinics. And these clinics provided treatments from a range of conditions, such as vision defects, external eye diseases, dental problems and vermin. And this went along and in conjunction with the preventive screening that I mentioned in the previous slide in relation to inspecting children during periods of epidemic outbreaks. So what clinics were doing is blaring the boundaries here between preventive and curative vantsen. So you have medically qualified doctors, aitingers, school medical officers who were providing not only preventive interventions such as immunizations and vaccinations but also the treatments for ailments that emerged within the child. And what is also crucial again to reemphasize is this link between the school and home. And this is also recognized by the British Broad of Education who argued that all the services that were taking place within schools would be relatively ineffective unless the personal and home life of the child were also brought under the system of domestic supervision. The home is the point which the health of the child must be controlled ultimately. And this provides the link which we are going to develop later in the class between schools and homes.

So you have a sample of source of preventive services that school medical officer was providing, you have a photograph here with dip syrias testing in Milwaukie in 1930s that happily smiled children. And it's a similar source of examples taken from Taiwan in 1960s. In the top-left you have the hearing inspector examining for headlights in the UK, we told it a mikinora and unsure of the nationalities have a monica for the head nurse as we called them. And at the bottom-right you have an example of the treatments that were provided in some of the school clinics. Here is an examination for dental carriers and in the treatments of trachoma also from Taiwan in 1960s. So the sources of services that were developed in Europe and North America of the beginning of the 20^th century permeated and were adopted on a global scale throughout the 20^th century.