Medical Inspection of Schools

British Columbia. Provincial Board of Health. Guidelines for the Medical Inspection of Schools (1913)

Chapter 1 - To the Teacher

Part 1 - General Instructions

At the beginning of each term make a routine inspection of all the children in the room. Scholars with a rash of any sort, sore eyes, severe enough or cold, vermin of whatever nature, ringworm, or running sores should be referred at once to the Medical Inspector.

Re-admit the pupil when he presents a medical certificate of health satisfactory to the Medical Inspector.

Render every assistance possible to the Medical Inspector in his visits, pointing out any cases requiring special attention.

Test the vision of each child, using the eight-testing card provided by this office. If your room is not so provided, write for one at once.

The test-card is fastened to the wall in a good light, so that the bottom is on a level with the eyes. Twenty feet measured from it and marked on the floor with chalk in the distance at which the child to be tested should stand. With good vision the child should be able to read the line marked D-20. If he fail he should be called upon to read the letters in the line above, D-30. If again unsuccessful, try him with the line above, D-40, and so on up until he is able to read the type correctly.

Children wearing spectacles should be regarded as having the vision they attain when wearing glasses.

Make a note of each child not having normal vision, marking what line he is able to read, and hand this report to the Medical Inspector when he inspects the children of your room.

In the every-day work of the school-room defects of hearing are quickly noted.

While medical inspection may appear to throw more work on the teacher, yet when carried out satisfactorily it tends to make the whole school-work easier and more efficient.

A healthy child makes a more intelligent pupil.

Extracts from "Schools Health Inspection Act."

The Board of School Trustees, or teacher in charge, shall cause to be referred to a School Health Inspector (who in such case must be a duly qualified medical practitioner) for examination and diagnosis, as follows:

  1. Every child returning to school without a certificate recognized by the local health authorities after suffering from or being exposed to any contagious or infectious disease:
  2. Every child who has been absent on account of illness or from unknown cause:
  3. Every child who shows signs of being in ill-health or suffering from contagious or infectious disease, unless he is at once excluded from school by the teacher.
No child so referred to the School Health Inspector shall be permitted to return to school unless and until he delivers to the teacher in charge of the school a written certificate, signed by such Inspector, permitting such return.

In the case of schools in remote and isolated situations, the Board of School Trustees of teacher may make such other arrangements as may best carry out the purposes of the Act.

Whenever a child shows symptoms of small-pox, scarlet fever, measles, chicken-pox, tuberculosis, diphtheria, or influenza, tonsilitis, whooping cough, mumps, scabies, ring worm, trachoma, or any other contagious or infectious disease, he shall immediately be sent home by the teacher in charge, or as soon as a safe and proper conveyance can be found, if such is necessary, and the Local Board of Health and Board of School Trustees shall at once be notified by such teacher.

Part II - Form A

In filling out Form A. the upper part is to be filled out exactly from Form A 1, the parentís or guardianís report. This section is filled out but once for each child. Endeavour to have this completed early in the school-year, so that it may be inspected by the school doctor.

One column of the first half of the year may be filled every year.

  1. For the school-year the first half of the year may be designated; e.g., the year 1912-13 may be signified as 1912.
  2. Give the number of the grade for the class. In the case of one grade requiring two years, write [? not transcribed]. Write Jun. for junior or Sen. for senior after the grade number; e.g., V. Sen.
  3. In measuring the height, have the child stand erect with his feet together, and the weight on the heels and not on the toes or the outside of the feet. If the boots are worn, deduct the height of the heels before recording.
  4. Endeavour to give as near the correct weight as possible, ordinary clothes being worn.
  5. Conduct may be described as good, fair, or bad.
  6. Endeavour may be earnest or dull.
  7. Proficiency may be good, fair, or poor.
  8. Cleanliness may be clean, somewhat dirty, dirty.
Kindly make all entries in small writing, using a fine pen and a good quality ink.
Bear in mind that the card — Form A — has to last the whole school-life of the child.
When a child transfers from another school within the Province, secure his previous card.
Read carefully the "General Instructions" on the back of the card.

Chapter II - To The Medical Inspector

Examine each child individually, taking special not of the various points enumerated on Form A under "Health Inspectorís Record." The inspection of an average normal child requires about five minutes.

For the annual physical examination examine each child in a private room, apart from the general class-room during school-hours. The upper part of the clothing should be loosened so as to expose the upper part of the chest. (If objection is raised to this procedure it may be dispensed with.) The examination of two children at the same time frequently reassures those who are timid.

First note any peculiarity as to gait, general condition, and appearance, size and shape of the lead, or as to clothing, foot-gear, and personal cleanliness; at the same time estimate the general nutrition and physical condition of the child.

The examination of the body may be best accomplished by commencing at the head and working downwards. Ringworm and vermin of the head should have been previously searched for by the teacher. Defects of vision and hearing will be pointed out by the teacher. Those defective will be re-examined by the doctor. Discharges from the ears or gluing of the lids. The presence of synechiae or adhesions and the condition of the lens should be observed. Examine for defective nasal breathing.

In the examination of the mouth and throat, wooden tongue-depressors are to be employed. These depressors must never be used more than once. The number of decayed and missing teeth, the condition of the tonsils, and the probable presence of adenoids are all noted. In recommending treatment for tonsils, temporary enlargement must be differentiated from permanent enlargements, which require operative treatment.

Digital exploration for adenoids is not recommended, as it tends to frighten the child and renders it more difficult for the Medical Inspector to perform his general examination.

The neck is next palpated to detect the presence of enlarged glands. These are present in a large number of children, the enlarged submaxillary being due to carious teeth and the enlarged posterior cervical to uncleanly conditions of the scalp.

General chest-development and the state of the heart, lungs, and spine are next observed. This examination should include the usual methods of clinical examination, inspection, palpation, and auscultation. Early signs of lateral curvature of the spine are to be searched for. It will be seen at a glance which children require a thorough examination. Any abnormalities should have the teacherís attention directed to them and definite instruction given as to the necessity for any departure from the ordinary school-work or games.

Deformities of the legs or feet are to be noted.

The examination of the childís mental capacity and the general state of the nervous system is to be next conducted. If the child counts slowly up to twelve (12), defects of speech may be noticed. The mental capacity may be gauged by the general deportment of the child, his answers to questions, and the teacherís report. It may be, classed as follows :

The various points observed in the examination of the child are to be recorded on Form A, which is kept in the schoolroom. Records must also be kept for the Medical Inspectorís annual report, one line of which is to be used for each room. The tabulated form should be filled in at the annual inspection while the results are still fresh in the doctorís mind.

Medical inspection involves the systematic examination from a medical point of view of the school premises, appurtenances, and methods, as well as examination of the children, so before leaving the school examine the general state of the school grounds and buildings, whether the rooms are clean, well lighted, or crowded; if the drinking arrangements are sanitary, or otherwise; if the grounds are clean and large enough; and if the closets are sanitary. These points are all to be directed to the attention of the teacher and School Board.

Get the pupils to take an interest in your visit by giving them a little talk on cleanliness, the benefit of fresh air, or on some subject bearing directly upon hygiene. In this and in many other ways the school doctor can make his visit to the classroom of great educational and hygiene value, of interest and stimulation in the teacher, as well as an hour of pleasure and happiness to the children.

"The function of the school doctor in relation to children in the schools is often mistaken even by medical men. It is no part of his duty to prescribe for or to treat any individual case. His work is prevenative, and in individual cases only, applies to matters involving educational questions. He can call attention to the need of glasses, but he has nothing to do with prescribing them. He may notice the presence of adenoids, but takes no part in their removal. On the other hand, his work should extend far beyond mere investigation of the sanitary state of the buildings or the exclusion of unhealthy or diseased children. The methods of education, the requirements of physical exercise, the avoidance — particularly in the very young — of overstrain from prolonged fatigue or from improper tasks, are all matters in which improvement can only be attained by the efforts of the school doctor. Above all, he must act, not as an authority to shut or close, to disturb or interrupt the proper work of the school, but as a counsellor and advisor with a knowledge of school routine and of the requirements of health, to assist and collaborate with the teacher and administrator, and it is with this purpose in mind that he should enter any school." - Hogarthís Medical Inspection of Schools,Chapter XI.
The annual report is to cover the school-year from September 1st to June 30th.

In addition to the examination at the school, pupils may be referred to the Medical Inspector at various times for the diagnosis of conditions which may require correction or the temporary exclusion of the child from school.

The Medical Inspector should exert every effort to win the confidence and co-operation of the teachers in the school. In the event of differences of opinion, full particulars of all facts relating thereto should be sent to this office.

Children requiring treatment are in all cases to be referred to their own physicians.

Write to this office if the school requires any of the forms provided for medical inspection.

Chapter III

Extracts From The "School Health Inspection Act."

The Provincial Board of Health shall appoint, in districts outside municipalities, one or more School Health Inspectors, shall assign to each Inspector of the schools to be inspected, and shall provide them with proper facilities for the performance of their duties as Health Inspectors of Schools and School Children.

Every School Health Inspector shall forthwith upon his appointment, and thereafter at least once in every school year, or oftener if required by the Board of School Trustees, make a thorough examination as to the general health of all children attending school in the district of which he is such Inspector, and of all, teachers and janitors in such district. He shall also carefully examine all school buildings and school surroundings in his district, and shall report to the said Board, fully and in detail, the result of such examinations. In such report he shall state whether or not he considers that the condition of health of any child, children, teacher, or janitor (naming them) is such as to endanger the health of the children at such school, and shall set forth his recommendations as to the school buildings and school surroundings.

The Board of School Trustees for the district shall forthwith act upon such report, and shall remove from the school any child or children, teacher, or janitor whose health is so reported by the School Health Inspector as being dangerous to children in such school, and such child, children, teacher, or janitor shall not be permitted to return to school in such district unless he or they deliver to the said Board a certificate in writing signed by such Inspector for the district, permitting such return.

The School Health Inspector shall have supervision over all physical exercises of pupils attending school, and in special cases may modify or prohibit such exercises.

The School Health Inspector shall, on the demand at any time of the Provincial Board of Health, make a report on the health conditions of the children attending any particular school or schools, or on any other condition in or around the school which might affect the health of the children.

An annual report shall be made at the termination of every school year by the School Health Inspector to the Provincial Board of Health; such report to be in such form as the Provincial Board of Health may require.

The Board of School Trustees, or teacher in charge, shall cause to be referred to a School Health Inspector (who in such case must be a duly qualified medical practitioner) for examination and diagnosis, as follows:

  1. Every child returning to school without a certificate recognized by the local health authorities after suffering from or being exposed to any contagious or infectious disease:
  2. Every child who has been absent on account of illness or from unknown cause:
  3. Every child who shows signs of being in ill-health or suffering from contagious or infectious disease, unless he is at once excluded from school by the teacher.
No child so referred to the School Health Inspector shall be permitted to return to school unless and until he delivers to the teacher in charge of the school a written certificate, signed by such Inspector, permitting such return.

In the case of schools in remote and isolated situations, the Board of School Trustees or teacher may make such other arrangements as may best carry out the purposes of this Act.

Whenever a child shows symptoms of small-pox, scarlet fever, measles, chicken-pox, tuberculosis, diphtheria, or influenza, tonsilitis, whooping-cough, mumps, scabies, ringworm, trachoma, or any other contagious or infectious disease, he shall immediately be sent home by the teacher in charge, or as soon as a safe and proper conveyance can be found, if such is necessary, and the Local Board of Health and Board of School Trustees shall at once be notified by such teacher.

It shall be the duty of the Board of School Trustees of each school district to see that the provisions of the "Health Act" are carried out as regards of the pupils attending school in their district.

The Provincial Board of Health shall prescribe the directions for tests of sight and hearing, and shall prescribe and furnish forms for test-cards, blanks, record-books, and other useful appliances for carrying out the purposes of this Act.


Source: British Columbia. Provincial Board of Health. Medical Inspection of Schools (Victoria, B.C.: King's Printer, 1913). Transcribed by Hayley Blain, History 349, Malaspina University-College, March 2001.