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CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW

FEVER—Continued.

Reports Received from Jan. 1 to July 1, 192!—Continued.

TYPHUS FEVER—Continued.

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CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW

FEVER—Continued.

Reports Received from Jan. 1 to July 1, 1921—Continued.
TYPHUS FEVER—Continued.

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PUBLIC HEALTH REPORTS

VOL. 35 JULY 8, 1921 No. 27

SICKNESS AMONG SCHOOL CHILDREN.

Loss oi Time From School Among 6,130 School Children in 13 Localities in Missouri.'

By Selwtn D. Collins, Assistant Statistician, United States Public Health Service.

At the present stage of our knowledge of disease problems,- any records which show the true incidence of even a few diseases in an observed population are important. Ordinary morbidity reports as furnished by physicians to local health departments do not, for wellknown reasons, give an accurate picture of the incidence of any disease in a definitely enumerated population group. It is necessary, therefore, to utilize other methods for obtaining the desired information.

In a general way, the most promising directions for seeking data of this character are: (1) Records of disability among groups of insured persons associated in various kinds of sick-benefit associations; (2) records of sickness in groups of persons employed in industrial establishments where careful medical supervision and a system of disability records have been established^ (3) records of sickness in groups of individuals living in institutions or attending school; and 14) special surveys of population groups made for the specific purpose of ascertaining the incidence of a given disease or group of diseases.

In various prior publications the Public Health Service has presented statistics of disability among adult wage earners who are members of sick-benefit associations, and the results of special sickness surveys. In the hope of obtaining data regarding the incidence of diseases among children, an attempt was made in connection with the field studies in child hygiene in Missouri during 1919-20, to institute a system of sickness records in connection with the schools. This was undertaken purely as an experiment, and a limited number of schools were requested to cooperate with the Public Health Service for this purpose. The results are presented in the following pages. The work is being undertaken on a larger scale, not only in Missouri but in other States for the school session of 1921-22.

1 From Field Investigations in Child Hygiene, United States Public Health Service. The statistical part of thi.i study was conducted in the Statistical Office o( tho Public Health Service. . ,i •

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The data here presented were collected in 13 localities in the State of Missouri. These data were entered by the teachers on cards distributed by medical officers of the Public Health Service in charge of child hygiene studies in the several communities. A card was made out for each child, showing sex, color, and age, and record, by Bchool months, of the total possible number of days of school attendance,1 the days present, the days absent on account of sickness, and the days absent from causes other than sickness. The card also contained n record of the diseases the child had during each month of the session.

After the cards had been completed and collected, they were carefully edited for errors, and only those which seemed to be properly and accurately used were included in the tabulation. It is believed that the necessary selection of properly filled out cards did not eliminate a disproportionate number of any particular class, such as those showing an excessive amount of absence or attendance.

The records, even after careful editing, however, can be considered only as a preliminary experiment. The data were incomplete in many ways. Records showing the specific data desired on the card were kept only after the first of the year 1920, and in some localities they were begun even later. Data for the months prior to the beginning of any special records were taken from the regular school records and, therefore, vary in completeness in the different localities. The entries showing the specific diseases causing the absence were not complete; in the majority of cases the number of days absent because of sickness was shown without specifying the disease. It was therefore decided to compute only the percentages of the total possible days of school attendance which were lost on account of sickness of all kinds and of causes other than sickness, with certain other data based on those cards reporting the specific disease causing the absence.

Table I shows the size and location of the cities from which data were drawn. They range from one to twenty thousand in population, and arc fairly representative, average-sized cities of the State. No data from the larger cities were included.

> It was found that, according to the prerailing custom in keeping school records of enrollment, a child's name was dropped from the roll after three days' absence and reentered when he returnod. In tabulating the records for the purpose of counting the absence from school on account of sickness, a child's name wa9 not dropped from the roll except when he was permanently separated from the school, as in the case of a child who left the community, or who went to work, or some similar case. With this difference, (he total possible number of days of school attendance is the total number of days enrolled during the period used for the computation.

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