In the fall of 1914, the medical staff conducted a survey of its own
efficiency. A committee prepared questions concerning procedure, and
secured answers from each member of the staff. These answers were
compared and discussed in staff meetings and uniform rules were
finally adopted for examinations and recording.
In line with this, the staff somewhat earlier prepared rules for
reporting defects so that all records may be compiled on the same
basis. This standardization of work is an especially noteworthy
feature of the Cleveland system, and should furnish valuable
suggestions to medical inspection departments of other cities. A few
of the rules adopted by the staff will serve to indicate the nature of
their work:
_Teeth_--Report decayed first or second teeth, and reddened
and inflamed gums. Do not report loose first teeth.
_Tonsils_--Report cases with histories of recurrent
tonsilitis, and where the size of the tonsils causes
difficulty of swallowing or thick speech. Do not report
moderately enlarged tonsils with no history of tonsilitis
nor evidence of mechanical obstruction.
_Adenoids_--Report mouth breathers with characteristic
adenoid faces, convincing yourself as to diagnosis by having
the pupil say "l, m, n, o, p." Do not try to confirm the
diagnosis of adenoids by a digital examination of the
nasopharynx.
_Glands_--Report general glandular enlargement and cervical
enlargement of the lymphatic glands accompanied by
malnutrition and anemia. Do not report submaxillary
enlargement in recurrent tonsilitis or carious teeth or
post-cervical enlargement in pediculosis capitis, or in
impetigo or eczema of the scalp.
As a result of rules such as these, a given report means the same
thing to every member of the staff; only important defects are
stressed; and the effort to remedy them is concentrated where it will
be most effective. Statistics based on records such as these will be
reliable and may be used for scientific study.