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What is the individual student's first introduction to the health service? In most institutions the student meets at least some of the staff of this department immediately on his registration, for practically all give a compulsory physical examination to every student on entrance. (See Table 3.) The elaborateness of this physical examination varies again most widely from a thorough physical and

medical examination, in the top group of colleges, to an extremely cursory physical examination, in the lowest group of colleges administered by the members of the physical education department, whose training in most cases does not fit them to make any sort of medical examination. The cards on which the results of these physical examinations are entered are for the most part quite elaborate and permit of a very thorough study, not only of the student's health on entrance, but of his improvement while in college. Unfortunately, it would appear that these records, like so many others in colleges, are collected, filed, and forgotten. The use actually made of them in comparison to use that might be made, is apathetically small. Although 39 of the schools require a physical examination on entrance, only 22 report that they reexamine their students periodically; 36, however, state that they make follow-up examinations in all cases needing attention. This statement should not be received with too much optimism, however, since only 23 provide facilities for corrective work in their physical education departments. Twentynine institutions report thorough case histories and examinations, while 14 express dissatisfaction with the adequacy of the data they collect.

The practice of having the physical examination of all students made by the health service rather than by the physical education department would seem to be highly desirable. In the first place, the staff of the health service, theoretically at least, should be far better equipped to give a complete examination. In the second place, it would seem to be good practice to introduce the student at the earliest possible time to the personnel and facilities of the health service so that he may become familiar with them and establish a habit of consultation at need. Moreover, if the student who presents himself for examination has remediable defects, appointments for further examination or possible medical correction can be made by the one who is doing the examining. Students the country over criticize the amount of red tape that must be gone through on registration. It cuts one knot of this red tape if the physical examination is made by the people who will later help in the correction of discovered defects.

What use does the school make of these physical examinations? In theory, of course, they are supposed to aid in helping each student to his finest possible health. In practice, however, in the land-grant institutions, they are used largely in connection with physical education work and military drill. They exclude from strenuous gymnasium work and competitive athletics those whose physical defects--heart lesion for instance--make it dangerous for them to engage in this work, and those whose condition makes competitive athletics

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dangerous because of mental or emotional strain; they locate those needing special gymnasium work for the correction of defects; they check up on the general physical condition of the student and notify him of corrections needed-eye defects, etc.; and in a few instances they actually carry through the physical and medical history of the individual.

Theoretically they might also be used to bar from entrance into the institution the student who would be a menace to others if admitted, or whose nervous or physical condition militates against his success in the college community. In practice, however, only 11 of the land-grant institutions mentioned rejections of students on the basis of the conditions shown by the physical examination. The cause most frequently mentioned is active tuberculosis; venereal disease comes second in frequency. A few additional rejections were noted on marked neurosis, hyperthyroid condition, and epilepsy. In all these cases, however, the institution was careful to say that the student was advised and urged not to matriculate rather than that he was actually barred from admission.

Although the correction of physical defects by appropriate supervision and exercise is one of the primary objectives of the physical examination, only 23 of the land-grant institutions state that they provide in their physical education departments remedial and corrective gymnasium work. Even in some of those that claim to care for their students in this way, a check of the equipment and staff of their physical education departments leads to skepticism about the positive value of the corrective work given. Yet surely this is one of the services that would react most markedly upon the effectiveness of classroom work—one of the primary reasons for the establishment of health service. Only six of the land-grant institutions say they reexamine all cases shown on first examination to have remediable defects. The same six institutions state that they give medical corrective treatment, and three of them also provide surgical corrective treatment. In the light of the showing both in the Arnıy tests and the elementary school health examinations it would seem that much greater attention should be given by the land-grant institutions to raising the health effciency of their student bodies.

After his physical examination the student's next contact with the health service is probably when he is ill. Most of the land-grant institutions provide some sort of infirmary where students can go to consult the health officer. The range is from a small single room which seems to be a combined office and waiting room to a complete, though possibly small, modern hospital.

Thirty-four of the schools reported that their health officers had a private office; eight said that he did not. Thirty-six institutions had a waiting room. What it led to in the case of the two institutions whose reports showed no private office one could only imagine, Thirty-three institutions reported ade

quate laboratory facilities as well as infirmaries; 10 were dissatisfied with their laboratory facilities. Only six of the colleges reported that there are no hospital facilities available in the community, and of these all but one provide student infirmaries. Many of the finest of these infirmaries were in the institutions where the university also has a well-developed medical school. At least six of the student infirmaries are completely equipped hospitals where all types of medical and surgical care can be given the student.

In analyzing student use of health service facilities, it was noticeable that where the rest of the report indicates excellence of service, use by the students is heavy; poor service is accompanied by little use. A comparison was made of the frequency of use by students in comparison with student population. This use varies from 12 calls per student to 16 calls per student, with the average around 3 per student per college year. The highest use made of health service facilities (16 calls per student) was in an institution exclusively for

Student use has no apparent relation to the health fee charge, as the number of calls per student in the institutions charging the least and the most was the same—0.3 per student.

Nineteen of the institutions reporting give some laboratory tests to all students. Of these the urinalysis is given by all and the hemoglobin by six, the rest mentioned various individual tests when necessity is indicated. It is interesting to note that the diseases watched for are peculiar to the location of the institution. In the South, inoculations against hookworm and malaria are frequent. The other tests mentioned were X-ray, Wasserman, throat smears, ringworm, and Schick test. Nineteen institutions require vaccination for smallpox, while 24 do not. Eight institutions, nearly all of them located in the South, require inoculation for typhoid, while 35 do not.

The greatest weakness noted in regard to the health service is the haphazard method of reporting cases of students who are ill. In schools where the students are housed in college owned or operated buildings, the check on student illness ought to be a very easy matter, but almost none of the land-grant institutions house a very large proportion of their students. The consequence is that the reporting of illness is left entirely to the voluntary good auspices of landladies, house mothers, solicitous friends, or the students themselves. . Though many of the schools expressed dissatisfaction with this method, few gave any constructive suggestions for its improvement. Where students live for the most part, as they do in the land-grant institutions, in privately operated rooming houses, it is possible for a boy, or less frequently for a girl, to be seriously ill for days without its causing solicitude on the part of anyone. While his absence from classes may be reported through his instructors to the college dean, there is no indication that the cause of absence is investigated until some untoward circumstance creates apprehension. There should be some means devised for remedying this serious defect.

It was interesting to note the steps taken in the various institutions after an illness was reported. Five schools take all the cases at once to the college hospital. The follow-up visit is made by a college physician in 23 cases; by a nurse in 8, by local physicians in 5. Two schools report that no visit is made

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even after a student is known to be ill. In one school the dean of men and the dean of women make the visits. In one, the official medical visit is made by the superintendent of buildings and grounds. Twenty-three of the instititutions have facilities for isolation wards in their own infirmaries, while 14 report that they send all cases of communicable diseases to outside hospitals. Four say that they isolate the students in their own homes. All of the institutions reporting showed excellent cooperation with city and county authorities in dealing with cases of communicable disease. Several mention careful observation of those exposed to infection, during the incubation period of a disease, and two require vaccination after exposure to smallpox.

Another duty of the college health service in many of the landgrant institutions is the issuing of excuses for students who have missed class because of illness. This whole matter requires almost a chapter by itself for it has come to be a real drain on the resources of the health service departments and in many cases defeats the very ends for which they were established. The underlying theory of having the health service issue excuses of this nature is that the health officer by seeing every student whose illness has caused absence can prevent such students from returning to class before it is safe for both himself and for his fellow students. Attractive as this theory may be, the results in actual practice do not support it. When there are so many excuses to be filled out, the inspection becomes mere perfunctory routine and defeats its own end, while at the same time it uses up a vast amount of the energy and time resources of the health service. In several schools the tendency would seem to be toward ignoring excuses altogether and putting the students on their own responsibility as to legitimate class absences, whether for illness or other causes. In most of the institutions reporting, however, this arrangement would seem to be far in the future.

In 31 of the land-grant institutions the physician or health officer issues all excuses for illness; in 7 the dean of men and the dean of women do it; in 2 the registrar; in 1 the college secretary; in 1 the school nurse. The prevailing skepticism regarding the validity of excuses issued by private physicians is shown in the fact that only one of the schools accepts them.

Twenty-two of the land-grant institutions charge a health service fee which provides infirmary service and medical care. The fee ranges from 90 cents to $12 a year, with the median at $6. In many cases this fee covers from two days to two weeks of hospitalization. The University of Wisconsin makes the most liberal provision, allowing hospital care for a whole semester or even longer in special cases, although the student might have been unable to register in the university because of his illness. In most of the colleges, when the illness lasts longer than the number of days allowed free, the cost is about $1 a day, although, as one institution points out, the cost to the health service is much higher, $3.89 in this case. Cost of care in the college hospitals where there is no health fee, ranges from 75 cents to $3.50 per day, with the average at $2. Where the college provides no infirmary and the student must depend on local hospitals for this care, the cost is from $3 a day in the wards to as high as $10 a day in private rooms. This is almost prohibitive for the average student in the land-grant institutions.

The cast of illness to needy students requires serious consideration. Many of the institutions make some sort of provision for such cases, but by no means the majority. The institutions that have complete

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