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hospital facilities in their own infirmaries report that they usually take care of all bills of needy students save surgical ones.
Eight institutions occasionally pay such bills; five arrange for the reduction of bills; five have loan funds available for such emergencies; two give longtime extensions on the bills; two mention a mutual benefit hospital association; two raise money for individual cases by appeals either to wealthy friends or to social agencies; one sends such students to the city clinic; and one reports that it makes no provisions whatsoever, but regards such matters as the student's own responsibility.
Ten institutions indicate that they make special arrangements for treatment of all their students by local physicians at a lessened cost, but 31 make no arrangements for such reduction of fees.
Because of the well-known hostility of the medical profession to any forms of socialized medical service, an attempt was made to discover how local physicians regarded such free or near-free service for students. Nineteen reported that the attitude is favorable; seven that it is indifferent; one, in a word that speaks volumes, says that improvement is noted; while four report distinct hostility. Since the right of industrial organizations to care for the health of their employees is unquestioned, it would seem that the medical profession should grant at least an equal right to educational institutions.
One of the new departments for the care of student health in higher institutions is that of mental hygiene. It is coming to be recognized that many illnesses, mental or emotional in their nature, that are as devastating as tuberculosis, may have no physical manifestation but may wreck a student's college work nevertheless. Two tendencies are shown in handling this phase of student health. The one which seems soundest in all respects is that of having a special physician trained in psychopathology attached to the regular health service. The other is to develop a certain amount of psychotherapy in relation to the department of psychology. Both plans claim the same benefit from their diverse methods; namely, that the student will be disarmed because of the usualness of the contact and will not regard himself as queer or possibly abnormal mentally. Since many students, however, who need attention from the mental hygienist also need a thorough examination in physical respects, this attention can be given with minimum effort and disturbance to the student if all the services of this nature are housed together on the campus. It would seem that there is far more danger of alarming the student about a possible stigma of mental queerness by having him secure the service in the psychology department than by having him go to the regular health service where he consults the specialist just as he would the oculist or the orthopedist. The person who is to do this work successfully on a college campus has need of the fullest medical as well as psychopathological training. It would seem to be the best practice, therefore, to make him one of the regular specialists in the health service staff.
Of the 42 institutions reporting on this portion of the questionnaire, only 9 make any provision for a separate division of mental hygiene. In five of these, the work is in charge of a physician who is primarily a mental hygienist; in four the work is in the department of psychology. Only two of the nine reporting institutions have full-time provision for this work on their campus. The remainder who have it at all indicate that the part-time workers who are doing it are insufficient for the amount and need of the work. All of these departments save one have been opened since 1923. Four additional schools report plans for such a department well under way, although the definite appointments had not yet been made at the time of this study. Twenty of the land-grant institutions (among them all of those where the work has been established) feel that a course in mental hygiene for all college students is desirable, although only a few make it available to the whole student body.
Before this work was established some apprehension was felt lest the students who needed it most would not use it. In actual experience no foundation for such fear exists. As soon as such a department begins to operate with any effectiveness on the campus, students come to it, usually in greater numbers than can be cared for efficiently. They come on the recommendation of instructors who have noticed peculiarities or who feel that there is some emotional disturbance behind the student's failure in class work; they come in sent by the deans of men and of women and the deans of the various colleges; they come because examination by the other physicians of the health service shows that they need to consult the mental hygienist; they come because they themselves are worried about their own mental or emotional disturbances; or they come because some friend is concerned about such manifestations. In one institution where the work was established late in the school year of 1927–28, by the end of the fourth month, 75 per cent of the patients were coming voluntarily and the demands for the service exceeded its capacity.
The significance of this work in its relation to the whole program of education is not yet generally understood. All the schools offering such service report that the results more than justify its continuance and that students are helped in making better adjustments in regard to their social life and vocational choices as well as in their school work. Practically all the students who had used the mental hygiene service had been benefited greatly by it. The number of students who had withdrawn from college on the recommendation of the mental hygienist was not large in proportion to the entire student body. It ranged from 1 to 16 cases for the year 1927–28. When it is realized that the program is as yet so limited that it reaches only from 3 to 15 per cent of the student body, the optimism in regard to its usefulness seems even more significant. Mental hygiene is evidently a phase of student health work that will show great development in the next decade.
In summary of this chapter certain facts stand out. The first is that the school can not free itself from the responsibility for the health of its students. It follows that adequate physical facilities must be provided and that these physical facilities must be staffed by a competent force of well-trained physicians and nurses.
It follows also that the cost to the student should be as low as is consistent with adequate service. The number of students in the land-grant institutions who are wholly or partly dependent upon their own earnings is very great. These students can not afford costly medical care. A liberal health fee to support such a staff and plant is really a form of student insurance and should be looked upon as such. Although many students do not need the services of such a department at any time during their courses, to other students it may mean the difference between prompt and adequate care and such poor attention that the student pays for it in lowered vitality for many years after. Especially in the institutions that are located at a distance from good hospital centers, student service is doubly necessary.
Another unavoidable conclusion from these reports is that the present method of discovering and checking on student illness is entirely inadequate. A few schools made definite suggestions for improving this part of the service. One of these suggestions is a definite education program both for the student body and for those responsible for the housing, as landladies, house mothers, etc., on the necessity for the early reporting of illness and on the facilities that the health service affords. This could easily be done by means of an attractive bulletin, write-ups in the school paper, lectures during freshman week, and discussion in such organizations as the meetings of householders which the dean of women frequently holds. A little well-directed publicity of this sort will go a long way, both in removing wrong impressions and in curing indifference. The very cheapness of the health service in some schools has militated against its use, excellent though it may be. If the care of the ill student after the health service has reached him is both efficient and sympathetic, it will go far toward overcoming any prejudices that may exist in the minds of the student's friends. It is no less true of the student health service than of commercial concerns that their best advertisers are satisfied customers.
Chapter VI.-Physical Welfare Including Athletics
The statement that the colleges and universities aim to educate the whole man, physically and spiritually as well as mentally is trite, but that this has been and should be their fundamental aim is as true as when the phrasing had the charm of novelty. For more than 50 years colleges in America have been providing some sort of physical training for their students. The aims of physical education in the schools of America have been: (1) healthful living habits including exercise; (2) correction of structural and posture defects; and (3) a sound foundation of hygienic information which should carry over into daily life.
However, study of the provisions made for the physical education of the students in the land-grant institutions presents real difficulty. One phase of physical exercise, that of intercollegiate athletics, has come to overshadow all the others to such an extent that it is impossiEle to separate it completely from the rest of the picture. It pervades the entire situation, affecting the selection of the staff, the provision of such facilities as playing fields, stadia, pools, and gymnasiums, and the financing of the entire program. In spite of this all-pervading influence, however, the number taking part in intercollegiate athletics in any single institution of the land-grant group is a very small per cent of the student body. The important concern here is the program providing for all the students rather than this selected few, reserving for the latter part of this section the treatment of the problem of intercollegiate athletics, both as it affects the participants and as it affects the rest of the institution. This leaves the topics of physical education and intramural sports for men and for women, and the teaching of hygiene to both men and women as the main topics to be treated here, although it will be necessary to consider the question of staff to some extent in this section,
Reports were received from 44 of the land-grant institutions. In 30 of these the physical education and the athletic programs are administered as a whole under one head while in 13 they are separated. Where they are unified the head of the entire division is usually called the director of physical education and athletics, although in 14 of the institutions the title of professor of physical education is used. Where the departments are separated the intra
mural athletics is never under the direction of the head of intercollegiate athletics but is grouped with the physical education work.
The director in most of the land-grant institutions has pretty full control of his department, just as the head of any other division, subject to the usual approval from the president and financial officers of the institution. He selects his own teaching staff, approves the purchase of equipment and the payment of bills, signs contracts, assigns teachers, and plans the class work for the department.
In studying the personnel of the staff the domination of intercollegiate athletics in the whole situation must be kept in mind. Otherwise it would be difficult to understand how 25 of the land-grant institutions could put at the head of such an important division of collegiate work men with only their first degree, and four could have in this position men who hold no collegiate degree whatever. In fact, the heads of only 3 of the departments studied held degrees higher than a master's; 12 held the master's degree. This is not equal to the collegiate training of any other teaching group in these institutions. Twenty-four of the land-grant institutions have no one in the department of physical education for men holding a degree higher than that of bachelor. The evident effort, however, to make this department an integral part of the college work was shown by the fact that these men were given full academic rank in many cases. Twenty-nine of the land-grant institutions report that the head of the department of physical education for men is given the rank of full professor; one that he is associate professor; one that he is assistant professor; 12 avoid the issue by using the title director.
The 44 institutions reporting had only 10 members of their staffs in these departments who were doctors of medicine, and only 5 who held the Ph. D. Four of these doctors of medicine were on one staff and three on another, leaving only three to be distributed among all the rest of the group. One school reported an interesting combination of functions—a man who held the title of professor of psychology and athletics and to whom was assigned the problem of research in the psychology of athletics.
It might be supposed that directing the work in physical education is peculiarly the province of young men, but a study of the ages of those reporting in the land-grant college survey would not indi. cate that the range is much different from that in other departments. Perhaps much of the rather grudging character of the recognition that other faculty members give to the departments of physical education may be traced back to the marked difference between the amount of training and the degrees held by the men in this division and their faculty rank and recognition by the administra