Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870-1930

Introduction

1 Introduction In the final decades of the twentieth century, American child health advocates and activist child healthcare providers rediscovered the urban public school as a potentially promising site for clinics that could deliver primary healthcare to city schoolchildren and youth. The need for such clinics had been made manifest by years of research, beginning with studies generated by the War on Poverty , demonstrating that economically disadvantaged inner-city children and youth received shockingly little basic medical and dental care or counseling and thus were very likely to have untreated conditions and defects or be at risk for developing them. Moreover, the logic behind siting such clinics in schools seemed both obvious and compelling. Schools were where the children were and thus where healthcare providers could have guaranteed access to them. Parents have to send their children to schools; they do not have to take them to private physicians’ and dentists’ offices or to public clinics. Additionally, since untreated diseases and conditions in schoolchildren were understood to contribute to absenteeism, distraction, dysfunctional behavior, and other causes of poor academic performance, it was arguable that schools had a vested interest in facilitating better healthcare for their students.1 Thus was born the school-based health center (SBHC) movement and the consequent proliferation of primary care clinics in the nation’s schools. In 1981, when SBHCs were made eligible for Maternal and Child Health Block Grant funding, there were less than a few dozen such centers. By 1990 there were 150. Today, there are an estimated 1,900 to 2,000, mostly in urban school districts but also in poor rural ones. Funded by a patchwork of federal, state, municipal , and private foundation money, they provide care for both adolescents 2 Classrooms and Clinics and younger children and offer an array of primary healthcare services typically including primary medical care, mental health and behavioral counseling , dental screening and treatment, and health education on nutrition, fitness, substance abuse, and sexual health. Although attracting considerable criticism from social and educational conservatives for ostensibly promoting liberal attitudes toward sexual activity and for diverting schools from their basic mission of education, the clinics are widely viewed by contemporary American healthcare reformers as one of the more significant innovations in child and youth healthcare to come out of their much-contested efforts to reorganize and make more equitably available medical, dental, psychological, and related services. Similarly, among contemporary American education reformers, the clinics are viewed as an important component of the full-service school, designed both to improve the physical and psychological well-being of poor city children and youth and to improve their ability to take advantage of the schooling the state is offering them.2 I describe the SBHC movement as originating in a rediscovery of the healthcare-delivery potential of urban schools because the movement does not represent the first time that American child healthcare activists and reformers cast their gaze on city schools and sought to use them to improve both the health and the academic performance of socioeconomically disadvantaged and medically underserved city children. In the early decades of the twentieth century, many of the nation’s large and midsize cities and a significant number of its towns experimented with a variety of methods and means to deliver healthcare services to schoolchildren in the primary grades. Then, as now, a major aim was to improve children’s health and thereby improve their academic performance. In Classrooms and Clinics, I examine that earlier attempt to use schools to provide health services to medically underserved children by situating it within a larger context: sociomedical and educational discourse in the late nineteenth and early twentieth centuries on the relation of schools and schooling , especially in cities and towns, to child health. My intent is to provide a comprehensive history and analysis of that discourse—universally referred to by its participants as school hygiene—and of the programs and policies it inspired. My hope is that in doing so I may provide some historical context for the fundamental issues, questions, and sociomedical arrangements that inform the current attempt to use schools to provide healthcare to the nation’s young. More important, I aim to illumine and explicate how school hygiene served as a critical site for the formative negotiation of the nature and extent of the public school’s—and, by extension, the state’s—responsibility for protecting Introduction 3 and...