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128 Conflict and controversy similar to that surrounding the efforts of school hygienists to combat malnutrition by establishing school feeding programs attended their efforts to facilitate the corrective treatment of those whom medical inspection had identified as having remedial defects. As was true with school lunches, a central and contentious issue was the relative responsibilities of the school and the family in guaranteeing that children received the treatment they needed. Like those opposing subsidized school lunches, opponents of schools’ playing more than a diagnostic and advisory role in securing treatment for children raised concerns about publicly funded education exceeding its mandate and, in so doing, both departing from its traditional educational mission and encouraging family irresponsibility and the proliferation of state socialism. Additionally, the school facilitation of treatment for correctible physical defects raised the question of at what point the pursuit of public health trespassed on the legitimate province of private practice. In the beginning, however, the major issue for those involved in medical inspection and school hygiene was how to convince the parents of students identified as having physical defects to seek treatment for their children. The Compliance Problem Implicit in the practice of sending notes home to parents listing a child’s observed defects and suggesting that he or she be taken to a private physician or clinic for further diagnosis and treatment was the assumption that remedial defects were widespread in schoolchildren in large part because parents were often unaware that the defects existed and could be corrected. Hence, it was From Coercion to Clinics The Contested Quest to Ensure Treatment Chapter 5 From Coercion to Clinics 129 assumed that parental notification would be sufficient to bring about a major improvement in the health and educability of the urban school population.1 It soon became apparent, however, that this was not to be the case. As a medical inspector writing in Popular Science Monthly dryly observed, “one of the principles of medical inspection of school children is to point out the defects, leaving it to those most interested in the welfare of the children to have them attended to and treated—a perfectly reasonable expectation which, however, like many other social theories and assumptions, is, unfortunately, not being borne out by actual facts.”2 Indeed, follow-up exams of children whose families had received notification revealed that in virtually every city where expanded medical inspection had been adopted, no more than 8–9 percent of families notified were actually following the postcard recommendations and taking their children to private physicians and dentists or to public clinics and dispensaries.3 Why such widespread noncompliance existed and what to do about it soon became topics of considerable discussion among school hygienists and others interested in the physical welfare of schoolchildren. Some blamed the notification system, contending that the notes often did not make it home and that, when they did, they were frequently not understood by parents whose English might be limited. Others blamed parental ignorance and superstitious belief in home and folk remedies, especially among poor immigrant families. In a talk delivered at the Fourth International Congress on School Hygiene, Jacob Sorbel, Josephine Baker’s second in command, recalled that parents would frequently respond to the notes that his inspectors sent home by insisting that there was nothing wrong with their children or that they could solve the problem themselves with a poultice or tonic they would concoct. Other school medical inspectors claimed that immigrant parents in particular believed that wearing glasses would destroy a daughter’s marriage chances, that swollen tonsils came from eating spicy foods and required only a change in diet to be cured, and that rows of decaying primary teeth were no problem since they were going to fall out anyway.4 Poverty or meager incomes were also frequently cited as a reason for parental noncompliance. Noting that uncorrected defects tended to be greatest in the neighborhood schools of the laboring poor, many of those involved in medical inspection suggested that lack of means and the consequent inability to afford remedial medical care kept many parents from following the written recommendations .5 As New York’s John Cronin noted, even those parents who came to agree that their child needed glasses were often prevented from providing them by the expense. Good refractive services were costly. Being properly fitted for and provided with corrective lenses by a qualified oculist—either an ophthalmologist or an optometrist—generally...

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